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Horm Metab Res 2016; 48(06): 359-371
DOI: 10.1055/s-0042-108071
Review
© Georg Thieme Verlag KG Stuttgart · New York

Corticosteroid-Binding Globulin: A Review of Basic and Clinical Advances

E. J. Meyer
1   Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
,
M. A. Nenke
1   Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
2   Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
,
W. Rankin
1   Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
2   Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
3   Chemical Pathology Directorate, SA Pathology, Adelaide, SA, Australia
,
J. G. Lewis
4   Steroid & Immunobiochemistry Laboratory, Canterbury Health Laboratories, Christchurch, New Zealand
,
D. J. Torpy
1   Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
2   Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
› Author Affiliations
Further Information

Publication History

received 16 December 2015

accepted 21 April 2016

Publication Date:
23 May 2016 (online)

Also available at
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Abstract

Corticosteroid-binding globulin (CBG, transcortin) is the primary cortisol binding protein. It is a non-inhibitory serine protease inhibitor, capable of conformational change from a high cortisol-binding affinity form to a low affinity form upon cleavage of its reactive centre loop by various proteases, such as neutrophil elastase. The burgeoning inflammatory role of CBG applies to acute, severe inflammation where depletion is associated with mortality, and to chronic inflammation where defects in cortisol delivery may perpetuate inflammation. Naturally occurring human mutations influence a wide range of CBG properties and point toward a role in hitherto unexplained chronic musculoskeletal pain and fatigue disorders as well as potentially affecting fertility outcomes including offspring gender. In vitro and knock-out animal models of CBG propose a role for CBG in cortisol transport to the brain, providing a foundation for understanding the human observations in those with CBG mutations and sex differences in stress-related mood and behaviour. Finally, CBG measurement has a practical role in the estimation of free cortisol, useful in clinical circumstances where CBG levels or cortisol binding affinity is reduced. Taken together, novel data suggest a role for cortisol in targeted cortisol delivery, with implications in acute and chronic inflammation, as well as roles in metabolism and neurocognitive function, implying that CBG is a multifaceted component in the mechanisms of hypothalamic-pituitary-adrenal axis related homeostasis.

Key words

cortisol - high-affinity CBG - low-affinity CBG - inflammation
 

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