Brix JM, Tura A, Herz CT, et al. - In this investigation involving 1,249 nondiabetic patients with morbid obesity [79.8% females, mean BMI 44.9 ± 6.5 kg/m ², mean age 38 ± 11 years], the authors discovered that patients with higher cortisol excretion have a better metabolic profile despite being more obese. Such findings warrant further investigation into the underlying mechanisms.

• In terms of cortisol excretion, patients were divided into three tertiles (urinary cortisol ≤ 51.6, > 51.6 and < 117.6, and ≥ 117.6 μg/24 h, respectively).

• Patients in the highest tertile were younger, more obese, and had lower diastolic blood pressure ([DBP]), total and LDL cholesterol, fasting and 2-h glycemia, 2-h insulinemia, and HbA1c, as well as a higher estimated glomerular filtration rate (eGFR).

• In addition, the glucose and insulin area under the curve (AUC) were lower.

• Urinary cortisol excretion was found to be positively correlated with body weight (BW) and overall glucose tolerance, and negatively correlated with HbA1c, 2-h glycemia, AUC glucose, and DBP after adjusting for age, gender, and eGFR.

• After multivariable analysis, HbA1c, BW, and DBP remained significant.