In Vivo Study of Interactions Between the Endocannabinoid System and the Corticotropic Axis in Man (VISECA)

University Hospital of Bordeaux

Status: Completed

Conditions: Cushing's Syndrome

Treatments: Procedure: Hypercortisolism; Other: Control; Other: Obese; Other: Hydrocortisone

Study type: Interventional

Funder types: Other

Identifiers

NCT02889224

CHUBX 2010/34

Details and patient eligibility

About

Working hypothesis: the interactions between the endogenous endocannabinoïds (ECS) - and cortisol, the end product of the Hypothalamo-Pituitary-Adrenal (HPA) axis may play a role in the pathophysiology of Cushing's syndrome.

The investigators speculate that:

• acute or chronic variations in plasma cortisol may induce changes in the activity of the ECS
• that there is a circadian rhythm of the ECS driven by the rythm of plasma cortisol

Full description

The study aim to identify the relationship between the ECS and the HPA axis in humans with a main objective to assess if Cushing's syndrome induces changes in the ECS activity.

For this purpose:

1. the investigors will compare plasma levels of ECS between obese controls and patients with Cushing's syndrome
2. the investigors will compare plasma levels of ECS in patients with Cushing's syndrome before and immediately after curative surgery
3. the investigors will compare plasma levels of ECS in patients with hypoadrenalism before and after the intake of substitutive doses of hydrocortisone
4. the investigors will evaluate the plasma levels of ECS during a short synacthen test in healthy subjects.

Enrollment: 40 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

For all patients groups:

• Age ≥ 18,
• Social security.

" Hypercortisolism " group:

• 18 < BMI < 40 kg/m2,
• Cushing's syndrome in front of :
• impaired 1 mg dexamethasone test (08:00 A.M. cortisol > 50 nmol/L)
• qualitative and quantitative disrupted circadian rhythm of cortisol with increased plasma concentrations
• free urinary cortisol upper normal range (90 µg/24H),
• Hypercortisolism that can be treated with surgery (adrenal adenoma treated with adrenalectomy or Cushing disease treated with pituitary surgery).

" Obese " group:

• Obese patients: 30 < BMI < 40 kg/m2,
• Normal HPA axis function:
• 08:00 A.M. cortisol > 250 nmol/L and peak above 550 nmol/L after 1 mg SST,
• Normal 24H free urinary cortisol and dexamethasone test. " Control " group:
• Lean or overweight patients (18 < BMI < 30 kg/m2),
• Non cortisol secreting pituitary or adrenal tumor,
• Patient in whom a biological evaluation of the HPA axis is recommended.

" Hydrocortisone " group:

• Lean or overweight patients (18 < BMI < 30 kg/m2),
• Primary or secondary adrenal insufficiency,
• With a need for hydrocortisone supplementation.

Exclusion criteria

• Patients with eating disorders, major depressive disorders or psychiatric disorders other than Cushing's syndrome,
• Cannabis consumption, alcoholism or drug addiction,
• Active smoking,
• cortisone treatment other than hydrocortisone,
• Pregnancy or feeding,
• Surgery for obesity,
• Incapability,
• Pathology that is life-threatening in the short term,
• Any situation that interfere with study or is risked for patient.

Trial design

Primary purpose: Other

Allocation: Non-Randomized

Interventional model: Single Group Assignment

Masking: None (Open label)

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40 participants in 4 patient groups

Obese

Active Comparator group

Description:

Subjects with BMI between 30 - 40 kg/m2 and no alteration of corticotrope axis.

Treatment:

Other: Obese

Hypercortisolism

Experimental group

Description:

Subject with BMI between 18 - 40 kg/m2 and presenting a hypercortisolism defined by HAS (Haute Autorité de Santé).

Treatment:

Procedure: Hypercortisolism

Hydrocortisone

Experimental group

Description:

Subject with BMI between 18 - 30 kg/m2 and with adrenal or corticotrope failure

Treatment:

Other: Hydrocortisone

Control

Experimental group

Description:

Subject with BMI between 18 - 30 kg/m2 and with a pituitary or adrenal tumor without effect on corticotrope axis.

Treatment:

Other: Control