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Abnormal Urinary Steroid Profiles in Hypertensive Obese Children

Obesity is associated with serious metabolic co-morbidities including hypertension, glucose intolerance, and dyslipidemia. Many obese patients also have increased central body fat and striae. These frequently encountered clinical findings are strikingly suggestive of hypercortisolemia, and have prompted studies of the relationship between obesity and the hypothalamic-pituitary-adrenal (ΗΡΑ) axis. Surprisingly, in otherwise healthy, obese children without diabetes mellitus, the 24-hour integrated concentration (the average plasma level of a hormone during a day) of cortisol is lower than in aged-matched lean children. When the diurnal pattern is examined, average cortisol levels are lower both day and night in obese compared to lean children. It is unclear what factors contribute to reduced integrated concentration (IC)-cortisol in obese children. Reduced ICcortisol levels are not associated with a reduction in cortisol-binding globulin (CBG); neither is there a concomitant increase in plasma levels of cortisoFs inactive metabolite, cortisone. Obesity is associated with increased urine clearance of free cortisol and other adrenal steroid metabolites'. If increased metabolic clearance of cortisol leads to reduced IC-cortisol, this would suggest the lack of a compensatory response by