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J Affect Disord. 2016 Nov 1;204:187-96. doi: 10.1016/j.jad.2016.06.024. Epub 2016 Jun 21.

Relative hypocortisolism is associated with obesity and the metabolic syndrome in recurrent affective disorders.

Author information

1
Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden. Electronic address: martin.maripuu@umu.se.
2
Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden.
3
Division of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.

Abstract

BACKGROUND:

Cardiovascular disease (CVD) is one of the main causes of excess deaths in affective disorders. Affective disorders are associated with increased frequencies of CVD risk-factors such as obesity, dyslipidemia, and metabolic syndrome. Stress-induced chronic cortisol excess has been suggested to promote obesity and metabolic syndrome. Chronic stress with frequent or persisting hypothalamic-pituitary-adrenal-axis (HPA-axis) hyperactivity may, over time, lead to a state of low HPA-axis activity, also denoted hypocortisolism. A low-dose weight-adjusted dexamethasone-suppression-test (DST) is considered to be a sensitive measure of hypocortisolism.

METHODS:

245 patients with recurrent depression or bipolar disorder and 258 controls participated in a low-dose DST and were also examined with regard to metabolic status.

RESULTS:

Patients with hypocortisolism (low post-DST cortisol) compared with patients without hypocortisolism (normal or high post-DST cortisol) exhibited increased odds ratios (OR) for obesity (OR=4.0), overweight (OR=4.0), large waist (OR=2.7), high LDL (OR=4.2), low HDL (OR=2.4), high LDL/HDL ratio (OR=3.3), high TC/HDL ratio (OR=3.4) and metabolic syndrome (OR=2.0). A similar pattern but less pronounced was also found in the control sample.

LIMITATIONS:

The cross sectional study design and absence of analyses addressing lifestyle factors.

CONCLUSIONS:

Our findings suggest that a substantial portion of the metabolic disorders and cardiovascular risk factors seen in recurrent affective disorders are found among individuals exhibiting hypocortisolism. This might indicate that long-term stress is a central contributor to metabolic abnormalities and CVD mortality in recurrent affective disorders.

KEYWORDS:

Affective disorder; Cortisol; Dyslipidemia; Hypocortisolism; Metabolic syndrome; Obesity

PMID:
27367307
DOI:
10.1016/j.jad.2016.06.024
[Indexed for MEDLINE]

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