Tuesday, June 23, 2009

Persistent Body Fat Mass And Inflammatory Marker Increases After Long-Term Cure Of Cushing's Syndrome

Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2009-0766

María-José Barahona*, Nuria Sucunza, Eugenia Resmini, José-Manuel Fernández-Real, Wifredo Ricart, José-María Moreno-Navarrete, Teresa Puig, Jordi Farrerons,  and Susan M. Webb

Endocrinology and Medicine Departments and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Hospital Sant Pau, Universitat Autònoma de Barcelona; Endocrinology Department, Institut d'Investigació Biomèdica de Girona (IDIBGI) and CIBER Fisiopatologia de la Obesidad y Nutrición CB06/03/010; Hospital Josep Trueta, Girona; Epidemiology and Internal Medicine Departments, Hospital Sant Pau, Universitat Autònoma de Barcelona, Spain

* To whom correspondence should be addressed. E-mail: 33962mbc@comb.cat.

Objective: Although increased central fat mass is characteristic of active Cushing's syndrome (CS), little is known on body composition and secretion of adipokines after long-term recovery of CS. The aim 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 years, mean time of hormonal cure: 11 ± 6 years) were enrolled and compared to 14 with active CS and 85 gender, age and BMI-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 TNF{alpha}-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 apoprotein 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 unfavourable adipokine profile, leading to a state of low-grade inflammation. This situation determines a persistent and increased cardiovascular risk in these patients.

Key words: Cushing's syndrome • fat mass • inflammation