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Obesity and Type 2 Diabetes Do Not Alter Splanchnic Cortisol Production in Humans

Division of Endocrinology, Metabolism, and Nutrition (R.B., A.B., E.G.C., R.A.R.), and Departments of Laboratory Medicine and Pathology (R.J.S.) and Vascular and Interventional Radiology (M.C.J.), Mayo Clinic, Rochester, Minnesota 55905; and Department of Information Engineering (G.T., C.C.), University of Padua, 35131 Padua, Italy

Address all correspondence and requests for reprints to: Robert A. Rizza, M.D., Mayo Clinic, 200 1st Street SW, Room 5-194 Joseph, Rochester, Minnesota 55905. E-mail: rizza.robert{at}mayo.edu.

Context: Cortisol is a potent regulator of carbohydrate, fat, and protein metabolism.

Objective: The objective of the study was to determine whether obesity alone or in combination with type 2 diabetes increases splanchnic and/or leg cortisol production.

Design: Splanchnic and leg cortisol production were measured using the hepatic and leg catheterization technique combined with infusion of D4-cortisol.

Setting: The study was conducted in a General Clinical Research Center.

Participants: Nine lean nondiabetic, 10 obese nondiabetic, and 11 obese diabetic subjects were studied.

Interventions: Diabetic volunteers were withdrawn from their glucose-lowering medications before study.

Main Outcome Measures: Rates of total body, splanchnic and leg cortisol, and D3-cortisol production were measured.

Results: Rates of splanchnic cortisol production equaled or exceeded those occurring in extrasplanchnic tissues (e.g. the adrenals) in all three groups. However, because concurrent splanchnic cortisol uptake also occurred, net splanchnic cortisol release was minimal. Splanchnic cortisol production and splanchnic D3-cortisol production (an index of splanchnic 11ß-hydroxysteroid dehydrogenase type 1 activity) did not differ among the three groups. In addition, splanchnic cortisol production did not correlate with either visceral fat or endogenous glucose production. On the other hand, splanchnic cortisol uptake was greater in the obese diabetic than lean nondiabetic subjects (25 ± 2.9 vs. 15.3 ± 2.5 µg/min; P < 0.05). Splanchnic, but not leg, D3-cortisol production was correlated with total body D3-cortisol production (r = 0.70; P < 0.001).

Conclusions: Although large amounts of cortisol are produced within the splanchnic bed, implying high intrahepatic glucocorticoid concentrations, rates do not differ in lean and obese nondiabetic humans and are not influenced by the presence of type 2 diabetes mellitus. On the other hand, obesity but not diabetes increases splanchnic cortisol uptake.

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