title: Relationships between 24-hour urinary free cortisol concentrations and metabolic syndrome in obese children.
abstract: BACKGROUND
  Clinical features of Metabolic Syndrome (MetS) and Cushing's Syndrome are similar, suggesting a pathogenetic role of hypothalamus-pituitary-adrenal axis in MetS.
  
  
  OBJECTIVE
  The aim of the study was to determine whether MetS diagnosis and specific clusters of MetS components (waist circumference, dyslipidemia, hypertension, and impaired glucose metabolism) are associated with serum cortisol (SC) or 24-h urinary free cortisol (UFC) levels.
  
  
  METHODS
  We conducted cross-sectional analyses of data from our obesity cohort. We studied 264 obese children (age, 11.0 ± 2.8 years; male, 48%; BMI, 28.2 ± 5.4 kg/m(2)). We examined UFC, SC, homeostasis model assessment (HOMA), and features of MetS (waist circumference, blood pressure, fasting lipids, and glucose).
  
  
  RESULTS
  Slightly increased UFC concentrations were measured in 30.7% of the children. Obese children with MetS had significantly (P = .003) higher UFC levels compared with obese children without MetS. Girls demonstrated significantly higher UFC concentrations compared with boys independent of pubertal stage. UFC and SC levels were significantly related to features of MetS, but the associations were stronger for UFC. In multivariate analyses adjusted for age, sex, and body mass index, none of the features of MetS but HOMA index was correlated with UFC, whereas SC demonstrated no significant association to any parameter of MetS or HOMA.
  
  
  CONCLUSIONS
  Our findings support the hypothesis that changes in the hypothalamus-pituitary-adrenal axis are related to MetS in obesity. UFC seems to be a suitable marker for this relationship. Norm values for UFC adapted to obese children may help to avoid unnecessary dexamethasone suppression tests.
authors.affiliation: Department of Pediatric Endocrinology (T.R., B.W., C.K., N.L.), Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Witten, Germany; Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics (A.K., M.W., P.-M.H.), University Hospital of Schleswig Holstein, Campus Kiel/Christian, Albrechts University of Kiel, Kiel, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Reinehr
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kulle
authors.forename: Barbara
authors.initials: B
authors.lastname: Wolters
authors.forename: Caroline
authors.initials: C
authors.lastname: Knop
authors.forename: Nina
authors.initials: N
authors.lastname: Lass
authors.forename: Maik
authors.initials: M
authors.lastname: Welzel
authors.forename: Paul-Martin
authors.initials: PM
authors.lastname: Holterhus
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002940:Circadian Rhythm; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine*; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology* / Q000652:urine; D063766:Pediatric Obesity / Q000097:blood / Q000453:epidemiology* / Q000652:urine
chemical_list: D006854:Hydrocortisone