Endocrine-metabolic pattern and adipose tissue distribution.

The associations between cardiovascular disease (CVD), non-insulin-dependent diabetes mellitus (NIDDM) and abdominal fat distribution are well established. The most important adipose tissue depot in this context is probably the mass of intra-abdominal adipose tissue which has been found to be associated with CVD, NIDDM and their established metabolic risk factors. This type of adipose tissue distribution is also associated with multiple endocrine aberrations, probably comprising an increased responsiveness of the hypothalamo-adrenal axis and a parallel or secondary decreased activity of the hypothalamic-gonadal axis. Epidemiological studies in both men and women indicate that this may be a consequence of psychological stress. Recently, indirect evidence for decreased production of growth hormone in this condition has also been recognized. These multiple and interrelated abnormalities comprise a syndrome where the primary disturbance could be localized to the hypothalamus and the main peripheral consequences would be metabolic effects on the mass and function of intra-abdominal adipose tissue. This in turn, probably by the effects of elevated concentrations of portal free fatty acid levels on the liver, could result in insulin resistance and other metabolic risk factors known to be strongly associated with CVD and NIDDM.