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Prediction of hypertension, diabetes and fractures in eucortisolemic women by measuring parameters of cortisol milieu

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Abstract

Purpose

Cortisol secretion, peripheral activation, and sensitivity seem to be associated with hypertension (HY), type 2 diabetes (T2D), and fragility fractures (FX) even in eucortisolemic subjects. The aim of the present study was to determine the cutoff(s) of the parameters of cortisol secretion and peripheral activation for predicting the presence of HY, T2D, and FX (comorbidities).

Methods

In 206 postmenopausal females (157 with ≥1 comorbidities and 49 without any), we assessed the ratio between 24-h urinary free cortisol and cortisone (R-UFF/UFE, cortisol activation index), cortisol after 1 mg-overnight-dexamethasone (F-1mgDST, cortisol secretion index), and the GC receptor N363S single-nucleotide polymorphism (N363S-SNP, cortisol sensitivity index).

Results

The cutoffs for F-1mgDST and R-UFF/UFE were set at 0.9 μg/dL (area under the curve, AUC 0.634 ± 0.43, p = 0.005) and 0.17 (AUC 0.624 ± 0.5, p = 0.017), respectively, predicted the presence of ≥1 comorbidities. The presence of F-1mgDST > 0.9 μg/dL plus R-UFF/UFE > 0.17 showed 82.1% specificity for predicting the presence of ≥1 comorbidities, while the simultaneous presence of F-1mgDST ≤ 0.9 μg/dL and R-UFF/UFE ≤ 0.17 showed 88% sensitivity for predicting the absence of comorbidities. The F-1mgDST > 0.9 μg/dL or R-UFF/UFE > 0.17 was associated with 2.8 and 2.1-fold increased risk of having ≥1 comorbidities, respectively. The F-1mgDST ≤ 0.9 μg/dL plus R-UFF/UFE ≤ 0.17 or F-1mgDST > 0.9 μg/dL plus R-UFF/UFE > 0.17 was associated with 2.8-fold reduced or 4.9-fold increased risk of having ≥1 comorbidities regardless of age, BMI, and N363S-SNP.

Conclusions

F-1mgDST > 0.9 μg/dL and R-UFF/UFE > 0.17 may be used for predicting the presence of ≥1 among HY, T2D, and fragility FX.

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Funding

This study was funded by Istituto Auxologico Italiano (Grant PRECOR Study 2019_01_29_06) and by the Italian Ministry of Health (Grant # RF 2013 -02356606).

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Authors and Affiliations

  1. Unit of Endocrinology, Fondazione IRCCS Cà Granda—Ospedale Maggiore Policlinico, Milan, Italy

    Valentina Morelli, Cristina Eller-Vainicher & Anna Maria Barbieri

  2. Unit for Bone Metabolism Diseases and Diabetes & Lab of Endocrine and Metabolic Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy

    Carmen Aresta, Alberto Falchetti, Luca Persani & Iacopo Chiodini

  3. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Carmen Aresta, Anna Maria Barbieri, Silvia Fustinoni, Elisa Polledri, Luca Persani & Iacopo Chiodini

  4. Department of Clinical and Experimental Medicine, University of Catania, University Hospital ‘G. Rodolico’, Catania, Italy

    Agostino Gaudio & Emanuela Orsi

  5. Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy

    Volha V. Zhukouskaya

  6. Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy

    Daniela Merlotti & Luigi Gennari

  7. Unit of Epidemiology, Fondazione IRCCS Cà Granda—Ospedale Maggiore Policlinico, Milan, Italy

    Silvia Fustinoni & Elisa Polledri

  8. Unit of Internal Medicine, Ospedale “Casa Sollievo della soffererenza” IRCCS, San Giovanni Rotondo, FG, Italy

    Vincenzo Carnevale

  9. Endocrinology and Diabetology, Ospedale “Casa Sollievo della soffererenza” IRCCS, San Giovanni Rotondo, FG, Italy

    Alfredo Scillitani

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  1. Valentina Morelli
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Correspondence to Iacopo Chiodini.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Morelli, V., Aresta, C., Gaudio, A. et al. Prediction of hypertension, diabetes and fractures in eucortisolemic women by measuring parameters of cortisol milieu. Endocrine 68, 411–419 (2020). https://doi.org/10.1007/s12020-020-02212-9

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