The cortisol awakening response is blunted in patients with active Cushing's disease

Author(s)

Ruiz Roa, Silvia Liliana ^[1] ; Lamparelli Elias, Paula Conde ^[1] ; Castro, Margaret ^[1] ; Moreira, Ayrton Custodio ^[1]

Affiliation

^[1] Univ Sao Paulo, Sch Med Ribeirao Preto, Dept Med, BR-14049900 Ribeirao Preto, SP - Brazil

• Document type: Journal article
• Source: EUROPEAN JOURNAL OF ENDOCRINOLOGY; v. 168, n. 5, p. 657-664, MAY 2013.
• Web of Science Citations: 5

Abstract

Introduction: Cortisol awakening response (CAR) is a rapid increase of cortisol levels within 30-45 min after awakening. Objective: This study evaluates CAR compared with cortisol circadian rhythm in active and in remission Cushing's disease (CD). Materials and methods: We evaluated healthy controls (HC, n = 19), obese (OB, n = 10), in remission (n = 08), and active CD patients (n = 10). Salivary free cortisol (SF) was determined at 0800, 1100, 1700, 2000, and 2300 h on the first day. CAR was obtained the next morning immediately upon awakening and at 15, 30, 45, and 60-min post-wake up. Results: We observed differences in SF levels throughout the day in HC, OB, and in remission CD (ANOVA P = 0.0001) but not in active CD (P = 0.2). We demonstrated SF increment after awakening in HC, OB, and in remission CD (ANOVA P = 0.007), with no effect of time on SF in active CD. The relative increment of SF obtained at the peak after awakening (CARi%) in the active CD (67 +/- 57%) was lower than in HC (154 +/- 107%), OB (240 +/- 188%), and in remission CD (186 +/- 184%) patients (P = 0.009). There was a negative correlation between the SF at awakening and the CARi% in HC (r = -0.8), OB (r = -0.78), and in remission CD (r = -0.74) but not in active CD (r = -0.35; P = 0.31). Conclusion: This study originally described a blunted CAR in active CD in contrast to its presence in HC, OB, and in remission CD. This subtle dysfunction of the hypothalamus-pituitary-adrenal axis may represent a distinct and additional physiopathological phenomenon superimposing the dysregulated cortisol circadian rhythm in this disease. European Journal of Endocrinology 168 657-664 (AU)

• FAPESP's process: 10/03039-7 - Cortisol awakening response (CAR) and circadian rhythm of cortisol in normal individuals and in Cushing's syndrome
• Grantee: Silvia Liliana Ruiz Roa
• Support Opportunities: Scholarships in Brazil - Master