title: Cortisol: the villain in metabolic syndrome?
abstract: OBJECTIVE
  This article reviews the state of the art regarding the association between glucocorticoid actions and both obesity and insulin resistance, two main features of the metabolic syndrome.
  
  
  METHODS
  A methodological assessment of the literature on PubMed and SciELO databases was conducted by using the following terms: stress, metabolic syndrome, glucocorticoids, obesity, insulin resistance, hypothalamic-pituitary-adrenal-axis and 11β-hydroxysteroid dehydrogenase.
  
  
  RESULTS
  Chronic stress, mainly through hypothalamic-pituitary-adrenal axis dysregulation, promotes the accumulation of visceral fat. Reciprocally, obesity promotes a systemic low-grade inflammation state, mediated by increased adipokine secretion, which can chronically stimulate and disturb stress system. This vicious cycle, probably initiated by visceral adipose tissue dysfunction, might be the trigger for the development of metabolic syndrome.
  
  
  CONCLUSIONS
  Given the strong evidences linking glucocorticoid release, obesity and type 2 diabetes, better understanding of the mechanisms underlying this connection might be useful for prevention and treatment of the metabolic syndrome.
authors.affiliation: Faculty of Medicine, University of Porto.
authors.forename: Sílvia
authors.initials: S
authors.lastname: Paredes
authors.affiliation: Department of Biochemistry and Center for Medical Education, Faculty of Medicine, University of Porto.
authors.forename: Laura
authors.initials: L
authors.lastname: Ribeiro
mesh_terms: D042842:11-beta-Hydroxysteroid Dehydrogenases / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology; D005938:Glucocorticoids / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007333:Insulin Resistance / Q000502:physiology; D050152:Intra-Abdominal Fat / Q000378:metabolism; D024821:Metabolic Syndrome / Q000209:etiology / Q000378:metabolism*; D009765:Obesity / Q000150:complications; D013312:Stress, Physiological / Q000502:physiology
chemical_list: D005938:Glucocorticoids; D042842:11-beta-Hydroxysteroid Dehydrogenases; D006854:Hydrocortisone