ESPE2021 ePoster Category 1 Adrenal B (10 abstracts)
Circadian rhythm of cortisol in saliva in obese children with clinical signs of hypercortisolism
María Gabriela Ballerini 1 , Andrea Josefina Arcari 1 , Luciana Brenzoni 1 , Analía Verónica Freire 1 , María Eugenia Rodríguez 1 , Andrea Amaro 1 , Débora Bravlavsky 1 , Irina Maggioni 2 , Ana Keselman 1 , Ignacio Bergadá 1 & María Gabriela Ropelato 1
1Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET – FEI – División de Endocrinología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina; 2División Laboratorio Central, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
Due to the increase in prevalence of childhood obesity, more obese children are referred to the endocrinologist for the hypothalamus-hypophysis-adrenal axis assessment. The circadian rhythm (CR) of cortisol in saliva (SAF) may constitute a non-invasive, first line test to exclude hypercortisolism on obese children.
Aim: To evaluate possible disturbances of CR of SAF in obese children with clinical signs of hypercortisolism.
Design: Cross-sectional, age-matched, observational, prospective study.
Subjects: Inclusion criteria for obese (OB) were BMI-centile≥95th and clinical signs of hypercortisolism. Exclusion criteria: non-Cushing syndromic obesity. NW inclusion criteria: 10th≤BMI-centile≤85th, absence of acute or known chronic disorders. Elimination criteria for both groups: incomplete or insufficient sampling, erroneous time collection, corticosteroid therapy. Cushing Syndrome (CS) diagnosis was based on clinical signs, biochemical tests and MRI images.
Methods: Saliva was collected at 8 a.m. (SAF8) and 23 p.m. (SAF23). SAF was measured by current ECLIA (Roche). Relative change at night (RCh%) was calculated as: [(SAF8 – SAF23) / SAF8] x 100. Subrogates of insulin resistance, HOMA-IR and TG/HDLcholesterol, were calculated in OB.
Results: 142 children: 69 obese (median age: 11.6years; 62 non-CS and 7 confirmed CS); weight gain and growth retardation(12.9%), moon face(28.5%), red striae(14.3%), headache(6.9%), hypertension(19%), hypertrichosis/hirsutism(39.7%), HOMA-IR>2.0 (60.3%), acanthosis nigricans(65.1%), gonadal dysfunction in girls(17.4%), acne(19%), dyslipidemia(80%), severe obesity (BMI-SDS≥3, 50.8%). 73 NW children (10.5years). SAF23 significantly decreased in NW and non-CS groups (P < 0.0001). Higher BMI-SDS was associated to lower SAF8 (r = -0.79, P < 0.001) and RCh% (r = -0.38; P < 0.001), therefore, data were adjusted by BMI-SDS (table, ***P < 0.0001 or **P < 0.001 versus NW). A higher proportion of TG/HDLc≥3 index was observed in non-CS children with RCh%<50%.
| Median(3rd-97th) | |||
| Obese | |||
| NW | non-CS | CS | |
| SAF8(nmol/l) | 12(5-25) | 7(3-15)*** | 36(14-44) |
| SAF23(nmol/l) | 2(2-4) | 2(2-5) | 21(9-82) |
| RCh% | 78(54-90) | 66(31-86)** | 41(26-49) |
Conclusions: In NW children, SAF by ECLIA decreased at least 50% at night being the RCh% a useful tool to interpret cortisol CR. In a small group of children with confirmed CS, SAF23 did not overlap to those obtained in NW or non-CS. Obese non-CS children had lower cortisol secretion in the morning and a lesser amplitude in the difference between morning and night SAF concentrations. Of concern, this result was associated to a more deleterious lipid profile in the obese. Non-CS obese may have a RCh%<50% (suggesting a blunted diurnal cortisol profile), therefore, this index should be interpreted with caution.
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