Persistent Body Fat Mass and Inflammatory Marker Increases after Long-Term Cure of Cushing’s Syndrome

• Published in: The journal of clinical endocrinology and metabolism Vol. 94; no. 9; pp. 3365 - 3371
• Main Authors: Barahona, María-José, Sucunza, Nuria, Resmini, Eugenia, Fernández-Real, José-Manuel, Ricart, Wifredo, Moreno-Navarrete, José-María, Puig, Teresa, Farrerons, Jordi, Webb, Susan M.
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Oxford University Press 01.09.2009; Copyright by The Endocrine Society; Endocrine Society
• Subjects: Adiponectin; Adiponectin - blood; Adipose Tissue - metabolism; Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Adrenocorticotropic hormone; Adult; Aged; Apolipoprotein B; Biological and medical sciences; Blood levels; Blood Pressure; Body composition; Body fat; Body mass index; Cardiovascular diseases; Cardiovascular Diseases - etiology; Cushing Syndrome - complications; Cushing Syndrome - metabolism; Dual energy X-ray absorptiometry; Endocrinopathies; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Humans; Inflammation; Inflammation - etiology; Insulin Resistance; Interleukin 6; Interleukin-6 - blood; Medical sciences; Middle Aged; Nervous system diseases; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Pituitary; Receptors, Tumor Necrosis Factor, Type I - blood; Remission; Risk Factors; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Endocrinopathy; Obesity; Adipose tissue; Adrenal cortex diseases; Nutrition; Cure; Nutrition disorder; Cushing syndrome; Biological marker; Metabolic diseases; Hyperadrenocorticism; Increase; Inflammation; Long term; Fat mass; Adrenal gland diseases; Endocrinology; Nutritional status
• ISSN: 0021-972X; 1945-7197; 1945-7197
• DOI: 10.1210/jc.2009-0766

Objective: Although increased central fat mass is characteristic of active Cushing’s syndrome (CS), little is known about body composition and secretion of adipokines after long-term recovery of CS. The aim of this study was to evaluate central fat mass and its correlation with adipokines and cardiovascular risk factors in patients after long-term remission of CS. Methods: Thirty-seven women with CS in remission (27 of pituitary and 10 of adrenal origin; mean age, 50 ± 14 yr; mean time of hormonal cure, 11 ± 6 yr) were enrolled and compared to 14 women with active CS and 85 gender-, age-, and body mass index-matched healthy controls. Total and trunk fat mass were measured by dual-energy x-ray absorptiometry scanning. Laboratory parameters and adipokine levels [including adiponectin, visfatin, soluble TNFα-receptor 1 (sTNF-R1), sTNF-R2, and IL-6] were measured. Results: Cured CS patients had more total and trunk fat mass than controls. Cured and active CS had higher levels of sTNF-R1 and IL-6 and lower adiponectin levels than controls. Higher insulin levels and blood pressure in both groups of CS patients and higher apolipoprotein B in cured CS were observed compared to controls. sTNF-R1 correlated positively with percentage of trunk fat mass and remained significant after adjusting for anthropometric parameters. Conclusion: Despite long-term cure, patients who have suffered CS exhibit persistent accumulation of central fat, as in active hypercortisolemia, with the consequent unfavorable adipokine profile, leading to a state of low-grade inflammation. This situation determines a persistent and increased cardiovascular risk in these patients.Despite long-term cure, Cushing′s syndrome determines persistent accumulation of central fat, an unfavorable adipokine profile, low-grade inflammation, and increased cardiovascular risk, as in active hypercortisolemia.