Patients in remission of Cushing’s disease may experience decreased total fat and improved cardiovascular risk factors, according to data from a prospective study.
Researchers examined 14 participants (12 women, 2 men) with active Cushing’s disease before transsphenoidal surgery and 6 to 8 months after glucocorticoids (remission), using whole-body MRI to pinpoint patients’ lean and fat distributions. One patient required two transsphenoidal surgeries before entering remission.
Of the 14 participants, 13 had hypertension, which was confirmed by a resting blood pressure higher than 140/90 mm Hg or the use of antihypertensive medications. At follow-up, only three participants had persistent hypertension.
Most participants remained in the overweight (BMI >25 ) or obese (BMI >30) category.
Eliza B. Geer, MD, researcher for the division of endocrinology at the Mount Sinai School of Medicine, and colleagues, investigated the link between body composition and CV risk in the altered bodies of patients with Cushing’s disease.
According to the study, remission decreased visceral, pelvic bone marrow, subcutaneous (including trunk and limb) and total fat; waist circumference; and weight (P<.05). The researchers found that remission altered fat distribution, which resulted in decreased visceral/total fat (P=.04) and visceral fat/skeletal muscle ratios (P=.006). In addition, CV risk factors such as insulin resistance, leptin and total cholesterol decreased (P<.05).
“Prospective studies of CD [Cushing’s disease] are needed to understand possible associations between previous or persistent abnormalities in adipose tissue distribution and cardiovascular risk markers in patients successfully treated for CD [Cushing’s disease],” the researchers wrote.
Further studies are needed to examine the lack of change in adiponectin, C-reactive protein and other lipid measures.
Disclosure: The researchers report no relevant financial disclosures.
Cushing’s disease alters fat distribution, muscle mass, adipokine profile and increases cardiovascular risk factors (serum insulin, glucose, leptin, high-molecular-weight adiponectin, C-reactive protein and lipid profile). Even though only a small group of 14 patients were studied, this is difficult to overcome in a rare disease like this.
They demonstrate that even though disease remission reduced most fat depots, dramatically improving body composition abnormalities, not all CV risk markers normalized completely; namely, adiponectin, C-reactive protein, and some lipid measures did not change after control of hypercortisolism. Furthermore, a decrease in skeletal muscle also persisted. This is interesting since one of the main complaints in patients “successfully” treated for Cushing’s disease is tiredness and fatigability, which persist beyond 1 year after surgery. This limits the patient’s exercise capacity and negatively affects their everyday life and subjective feeling of well-being, impairing their health-related quality of life.
Susan M. Webb, MD, PhD
Professor, Department of Medicine/Endocrinology
CIBER-ER, Unit 747 on Pituitary Diseases Hospital de Sant Pau
Universitat Autònoma de Barcelona, Spain