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Clinical Studies and Practice

Adrenal medullary dysfunction as a feature of obesity

International Journal of Obesity volume 41, pages 714–721 (2017)Cite this article

Subjects

Abstract

Background and Objective:

Although there is strong evidence linking obesity with increased sympathoneural activity, involvement of the adrenal medulla is less clear. We therefore investigated adrenal medullary function under fasting and feeding conditions in normal weight (NW, n=33), overweight (OW, n=28) and obese (OB, n=36) adults (59% women).

Subjects and Methods:

Ninety-seven healthy adults participated in a cross-sectional study with recruitment stratified according to BMI. Plasma for catecholamines and metanephrines was sampled in the fasting state, at 30-min intervals during a 120-min glucose tolerance test and during an euglycaemic-hyperinsulinaemic clamp (40 mU m−2 min−1 insulin dose). Body composition was determined by leg-to-leg bioelectrical impedance analysis.

Results:

Obese subjects had the lowest fasting plasma concentrations of epinephrine (NW: 0.17, 95% confidence interval (CI): 0.14–0.20 nmol l−1; OW: 0.16, 95% CI: 0.12–0.19 nmol l−1; OB: 0.11, 95% CI: 0.08–0.13 nmol l−1; P=0.018) and metanephrine (NW: 0.17, 95% CI: 0.15–0.19 nmol l−1; OW: 0.15, 95% CI: 0.13–0.16 nmol l−1; OB: 0.13, 95% CI: 0.12–0.15 nmol l−1; P=0.022), the latter reflecting adrenal medullary store size. Fasting plasma epinephrine (r=−0.437; P<0.001) and metanephrine (r=−0.477; P<0.001) concentrations were additionally inversely correlated with whole-body fat percentage. Suppression of epinephrine secretion in response to carbohydrate ingestion was significantly blunted in overweight and obese subjects compared with the normal weight subjects (Pinteraction=0.045). Most of the variance in basal epinephrine was related to whole-body fat percentage (β=−0.389, 95% CI: −0.09 to −0.69; P=0.012) that explained the lower concentrations of epinephrine and metanephrine in women than men.

Conclusions:

We provide evidence that adrenomedullary dysfunction is a characteristic feature of obesity that involves both reduced adrenal secretion of epinephrine and size of adrenal medullary epinephrine stores.

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Acknowledgements

We are grateful to all volunteers for their participation. We thank B Kindel and K Haink for their kind technical assistance. We express our gratitude to J Viehweg, K Löbmann and A Kästner for their support in the study organisation and recruitment. This study was supported by the University Hospital Carl Gustav Carus and the German Diabetes Foundation (271-07-10).

Author contributions

MR is responsible for the study design, general supervision, data collection, analysis and interpretation of data and drafting of the article. TZ is the responsible study clinician and contributed to the study design, data analysis and interpretation. MG and SRB were involved in the medical supervision and data acquisition. GE, CK and NQ contributed to data analysis and interpretation. GE was involved in the discussion and comprehensively revised/edited the paper before submission. All authors gave final approval of the current version to be published. MR is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis

Author information

Authors and Affiliations

  1. Department of Neurology, Autonomic and Neuroendocrinological Laboratory Dresden, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    M Reimann & T Ziemssen

  2. Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    N Qin & G Eisenhofer

  3. Department of Internal Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    M Gruber, S R Bornstein & G Eisenhofer

  4. Department of Biological Psychology, Technische Universität Dresden, Dresden, Germany

    C Kirschbaum

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  1. M Reimann
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Correspondence to M Reimann.

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Reimann, M., Qin, N., Gruber, M. et al. Adrenal medullary dysfunction as a feature of obesity. Int J Obes 41, 714–721 (2017). https://doi.org/10.1038/ijo.2017.36

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