A C‐1291G polymorphism in the α_2A‐adrenergic receptor gene (<i>ADRA2A</i>) promoter is associated with cortisol escape from dexamethasone and elevated glucose levels

. Rosmond R, Bouchard C, Björntorp P (Sahlgrenska University Hospital, Göteborg, Sweden; Pennington Biomedical Research Center, LA, USA). A C‐1291G polymorphism in the α 2A ‐adrenergic receptor gene ( ADRA2A ) promoter is associated with cortisol escape from dexamethasone and elevated glucose levels. J Intern Med 2002; 251 : 252–257. Objectives. The objective of the current study was to examine the potential impact of a C → G substitution at position −1291 of the α 2A ‐adrenergic receptor gene ( ADRA2A ) promoter on obesity and estimates of insulin, glucose, and lipid metabolism as well as circulating hormones, including salivary cortisol in 284 unrelated Swedish men born in 1944. Main outcome measures. The subjects were genotyped by using PCR amplification of the promoter region of the ADRA2A gene followed by digestion with the restriction enzyme Msp I. Results. The frequencies were 0.23 for allele C and 0.77 for allele G. The observed genotype frequencies were 45.8 and 54.2% for C/G and G/G, respectively. Heterozygotes ( n =121) had significantly ( P =0.009) higher salivary cortisol levels after 0.5 mg dexamethasone compared with G/G homozygotes ( n =143). Fasting glucose was found to be significantly ( P =0.017) higher in heterozygotes than in G/G homozygotes. The latter group had also a borderline significantly ( P =0.080) higher mean diastolic blood pressure. These results were all adjusted for the potential confounding effect of body mass index (BMI) and waist‐to‐hip ratio (WHR). Other measurements such as BMI, WHR, abdominal sagittal diameter, total testosterone, insulin‐like growth factor I, serum leptin, fasting insulin and serum lipids were not different across the ADRA2A genotype groups. Conclusions. In conclusion, we have shown that an C → G polymorphism at position −1291 of the ADRA2A gene is associated with a subnormal cortisol response to dexamethasone, elevated glucose levels and perhaps increased diastolic blood pressure. The pathophysiology could involve an altered density of the α 2A ‐AR that destabilizes the sympathetic–hypothalamic–pituitary–adrenal systems in those with genetic vulnerability in the α 2A ‐adrenergic receptor gene promoter.