Associations between pituitary–adrenocortical function and abdominal obesity, hyperinsulinaemia and dyslipidaemia in normotensive males

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Abstract
Hautanen A, Räikkönen K, Adlercreutz H. (University of Helsinki, Helsinki, Finland) Associations between pituitary‐adrenocortical function and abdominal obesity, hyperinsulinaemia and dyslipidaemia in normotensive males. Objectives: To examine the relationships between pituitary‐adrenal cortical (PA) function, abdominal obesity, hyperinsulinaemia, and dyslipidaemia. Design: A prospective study. Setting: Helsinki University Central Hospital, Finland. Subjects: Seventy‐one healthy males aged 30–55 years. Main outcome measures: Insulin sensitivity was assessed by the oral glucose tolerance test (OGTT). Basal PA activity was examined by measuring urinary and serum concentrations of hormones, followed by dexamethasone suppression and corticotrophin (ACTH) stimulation tests to determine functional PA activity. Results: The means of waist‐to‐hip ratio (WHR), body‐mass index (BMI), HDL‐cholesterol and triglyceride levels, and insulin and C‐peptide measurements during the OGTT were significantly different across the tertiles for insulin: glucose ratio. The ratio of 12‐h urinary cortisol excretion to BMI, preceding the OGTT, and the mean basal cortisol level during the OGTT were decreased, while the net increments of cortisol and 17‐hydroxyprogesterone (17‐OHP) from 0 to 60 min, as well as the ratio of net 17‐OHP to 11‐deoxycortisol increments, after ACTH, were elevated in the upper compared with the lower tertile. The mean cortisol during the OGTT, and the ratio of urinary cortisol to BMI were negatively related, while absolute DHEA and cortisol responses to ACTH were positively related to fasting and mean insulin levels. Hormonal variables, WHR. insulin, and triglycerides were successfully integrated into a tentative mathematical model by the use of covariance structure (path) analyses. Conclusions: Several alterations in the PA function, suggestive of decreased 21‐hydroxylase activity, mild cortisol deficiency and slight adrenal hyperplasia, are associated with abdominal obesity which, in turn, appears to be an important prelude to insulin resistance and dyslipidaemia.