title: Relative hypocortisolism is associated with obesity and the metabolic syndrome in recurrent affective disorders.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  The cross sectional study design and absence of analyses addressing lifestyle factors.
  
  
  
  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.
authors.affiliation: Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden. Electronic address: martin.maripuu@umu.se.
authors.forename: Martin
authors.initials: M
authors.lastname: Maripuu
authors.affiliation: Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden.
authors.forename: Mikael
authors.initials: M
authors.lastname: Wikgren
authors.affiliation: Division of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Pontus
authors.initials: P
authors.lastname: Karling
authors.affiliation: Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden.
authors.forename: Rolf
authors.initials: R
authors.lastname: Adolfsson
authors.affiliation: Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden.
authors.forename: Karl-Fredrik
authors.initials: KF
authors.lastname: Norrback
mesh_terms: D000309:Adrenal Insufficiency / Q000378:metabolism / Q000523:psychology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001714:Bipolar Disorder / Q000150:complications / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000378:metabolism / Q000523:psychology; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000378:metabolism; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000172:deficiency*; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism; D008297:Male; D024821:Metabolic Syndrome / Q000378:metabolism / Q000523:psychology*; D008875:Middle Aged; D019964:Mood Disorders / Q000150:complications / Q000378:metabolism*; D009765:Obesity / Q000378:metabolism / Q000523:psychology*; D016017:Odds Ratio; D050177:Overweight / Q000378:metabolism / Q000523:psychology; D010913:Pituitary-Adrenal System / Q000378:metabolism; D012008:Recurrence; D012307:Risk Factors; D055815:Young Adult
chemical_list: D006854:Hydrocortisone
keywords: Affective disorder; Cortisol; Dyslipidemia; Hypocortisolism; Metabolic syndrome; Obesity