Endocrine Weight Loss Cortisol, Stress Hormones, and Body Composition 2 — Questions and Answers
Question 1: Chronic high cortisol impairs weight management by antagonizing which anabolic hormone, contributing to muscle loss?
- Parathyroid hormone
- Insulin-like growth factor 1 (IGF-1) / growth hormone axis (Correct answer)
- Aldosterone
- Calcitonin
Correct answer: Insulin-like growth factor 1 (IGF-1) / growth hormone axis
Glucocorticoids suppress GH secretion and impair IGF-1 signaling, reducing protein synthesis and promoting muscle catabolism (proteolysis) that contributes to the sarcopenia of chronic cortisol excess.
Question 2: Which 24-hour urinary test is used to confirm autonomous cortisol overproduction in suspected Cushing's syndrome?
- 24-hour urine albumin
- 24-hour urine free cortisol (UFC) (Correct answer)
- 24-hour urine catecholamines
- 24-hour urine 17-ketosteroids
Correct answer: 24-hour urine free cortisol (UFC)
24-hour urinary free cortisol measures unbound cortisol excreted over a full day, reflecting integrated cortisol production and is one of the confirmatory tests for Cushing's syndrome.
Question 3: Adrenal insufficiency (Addison's disease) affects body composition by causing:
- Central obesity and moon face
- Weight loss, anorexia, and decreased muscle and fat mass (Correct answer)
- Muscle hypertrophy from excess ACTH
- Facial plethora and fluid retention
Correct answer: Weight loss, anorexia, and decreased muscle and fat mass
Adrenal insufficiency causes weight loss, anorexia, weakness, and reduced lean and fat mass due to deficiency of both glucocorticoids and mineralocorticoids.
Question 4: Which stress management intervention has the most evidence for reducing cortisol levels and supporting weight management?
- Brief daily exposure to cold temperatures
- Mindfulness-based stress reduction (MBSR) and regular aerobic exercise (Correct answer)
- Intermittent fasting protocols alone
- Social media abstinence programs
Correct answer: Mindfulness-based stress reduction (MBSR) and regular aerobic exercise
MBSR and regular aerobic exercise have the strongest evidence for attenuating HPA axis reactivity, lowering basal cortisol, and supporting metabolic health in overweight individuals.
Question 5: Which pattern of fat distribution is most cardiometabolically dangerous and associated with chronic cortisol excess?
- Gynoid (pear-shaped) subcutaneous fat distribution
- Android (apple-shaped) visceral fat distribution (Correct answer)
- Diffuse symmetrical subcutaneous fat gain
- Lower limb lipedema
Correct answer: Android (apple-shaped) visceral fat distribution
Visceral (intra-abdominal) fat is metabolically active, pro-inflammatory, and associated with insulin resistance, dyslipidemia, and cardiovascular disease; cortisol preferentially drives fat to this depot.
Question 6: Dehydroepiandrosterone (DHEA), an adrenal androgen, declines with age and is associated with:
- Increased visceral fat accumulation and decreased muscle mass (Correct answer)
- Improved insulin sensitivity and maintained lean mass
- Elevated cortisol-to-DHEA ratio favoring anabolic activity
- Reduced cardiovascular risk as DHEA decreases
Correct answer: Increased visceral fat accumulation and decreased muscle mass
Declining DHEA with age is associated with increased visceral adiposity, decreased lean mass, and worsening insulin resistance, partly because the cortisol-to-DHEA ratio rises, favoring catabolic effects.
Endocrine Weight Loss Cortisol, Stress Hormones, and Body Composition 2
Chronic high cortisol impairs weight management by antagonizing which anabolic hormone, contributing to muscle loss?