Cortisol levels might be increased in obesity leading to enhanced gluconeogenesis and inhibited glucose utilization. Subsequent release of catecholamines might additionally promote obesity. In morbid obesity, the association of cortisol excretion to metabolic parameters is not well characterized. We included 1249 patients with MO (76.8% females, mean BMI 45.6± 6.2 kg/m², mean age 40±12 years). Anthropometric data and cardiovascular risk factors were assessed and a glucose tolerance test (oGTT) for calculation of Insulin Resistance and Sensitivity indices was performed. All patients collected 24h hour urine specimens to assess cortisol excretion on two consecutive days. Regarding cortisol excretion, patients were divided into three tertiles (fist< 39.1 µg/24h, second between 39.1and 139.9 µg/24h and third >139.9 µg/24h. Patients in the highest tertile had a higher BMI (p= 0.015) and waist circumference (p= 0.029), however, exhibited a lower diastolic blood pressure (p=0.001), 1-hour (p=0.001) and 2-hour glucose (p= 0.003) as well as HbA1c (p=0.047) values. Area under curve (AUC) for glucose (p<0.001) as well as insulin (p= 0.018) were lower, and HOMA-beta was increased (p=0.006). We did not find any differences regarding OGIS or QUICKI. In a correlation analysis, cortisol levels were inversely associated with glucose-AUC (r=-0.206; p<0.001), HOMA beta (r= 0.084; p= 0.005), BMI r= 0.099; p=0.002), glucose 1-hour (r=-0.107; p<0.001) and glucose 2-hour levels (r=-0.107; p<0.001). Despite being more obese, patients with higher cortisol excretion present with a more favorable metabolic profile compared to those with lower cortisol excretion. These results deserve further attention regarding the respective potential mechanisms.


J. Brix: None. E. Krzizek: None. A. Tura: None. G. Pacini: None. B. Ludvik: Advisory Panel; Self; Amgen Inc., AstraZeneca, Boehringer Ingelheim International GmbH, Sanofi, Takeda Development Centre Europe Ltd. Research Support; Self; Akebia Therapeutics, Eli Lilly and Company, Novartis AG, Novo Nordisk A/S. Speaker's Bureau; Self; Merck Sharp & Dohme Corp.

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