Effect of Cortisol Production on Visceral Fat and Total Muscle Mass in Patients with Adrenal Adenomas.

Presentation Number: SUN 378
Date of Presentation: April 2nd, 2017

Danae Anastasia Delivanis*1, Zeb H Muhammad2, Michael R Moynagh3, Naoki Takahashi3, Nicole M Iniguez Ariza4, Melinda Thomas4, Travis J. McKenzie1, William F Young Jr.1, Venetsana Kyriazopoulou5 and Irina Bancos1
1Mayo Clinic, Rochester, MN, 2Department of Surgery, Endocrine Subspecialty, Mayo Clinic, Rochester, MN, 3Department of Radiology, Mayo Clinic, Rochester, MN, 4Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, 5Department of Internal Medicine, Division of Endocrinology, School of Medicine, University of Patras, Greece

Abstract

Objective: Abdominal visceral adiposity is a known cardiovascular risk factor and central sarcopenia is a marker of frailty and increased mortality. Patients with overt Cushing syndrome (CS) present with increased abdominal adiposity and proximal muscle weakness. Patients with glucocorticoid secretory autonomy without overt features of CS or subclinical CS (SCS) have higher prevalence of cardiovascular factors, which may correlate with cortisol-induced changes in body composition. We aimed to determine the effect of cortisol production on body composition in patients with adrenal cortical adenomas undergoing adrenalectomy.

Methods: We selected patients with CS, SCS and non-functioning adrenal tumours (NFAT) who had abdominal computed tomography (CT) imaging prior to adrenalectomy from the existent Mayo Clinic retrospective and prospective adrenal tumor databases. Diagnosis of glucocorticoid secretory autonomy was based on clinical and biochemical evaluation. Investigators blinded to clinical diagnoses performed measurements of intra-abdominal mean visceral, total fat, and muscle mass at 3 levels (L1-L2-L3). Analysis was performed based on clinical diagnosis of CS, SCS, and NFAT as well as in relation to serum cortisol concentrations after overnight dexamethasone suppression. Results were adjusted for age, gender, and BMI.

Results: A total of 113 patients (26 CS, 46 SCS, and 41 NFAT) met inclusion criteria. Median age was 54 yrs (range, 18-82) and 80 (71%) were women. Median BMI was 28 kg/m2 (range, 18-51). Median diameter of adrenal tumors was 3.5 cm (range, 1-16) and median CT radiodensity was 14 HU (range, -14 to 80). Patients with CS and SCS had a higher prevalence of hypertension compared to patients with NFAT (81% vs 65% vs 51%, respectively, P=0.04). Median visceral fat was 228 cm2 (range, 25-424), 131 cm2 (range, 19-492) and 168 cm2 (range, 5.8-510) in patients with CS, SCS and NFAT respectively, P =0.27. Median muscle mass was 113 cm2 (range, 67-190), 119 cm2 (range, 22-261) and 140 cm2 (range, 83-344) in patients with CS, SCS and NFAT respectively, P =0.004.When adjusted for gender, BMI and age, in comparison to patients with NFAT, visceral/total fat ratio was higher (0.08, P <0.001) and total muscle mass was lower (-9, P =0.05) in patients with overt CS but not in patients with SCS. In multivariable regression analysis, serum cortisol measurement after dexamethasone suppression was inversely correlated to muscle mass (-1.4, P =0.02), but not visceral adiposity.

Conclusion: Central sarcopenia, a known risk factor for increased mortality, correlated positively and significantly with the degree of hypercortisolemia, whereas differences in intraabdominal visceral adiposity were noted only in patients with overt CS.

 

Nothing to Disclose: DAD, ZHM, MRM, NT, NMI, MT, TJM, WFY Jr., VK, IB