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

Endocrinology and Medicine Departments and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), Instituto de Salud Carlos III, Barcelona, and Hospital Sant Pau (M.-J.B., N.S., E.R., S.M.W.), Universitat Autònoma de Barcelona, 08025 Barcelona, Spain; Endocrinology Department (J.-M.F.-R., W.R., J.-M.M.-N.), Institut d'Investigació Biomèdica de Girona and CIBER Fisiopatologia de la Obesidad y Nutrición CB06/03/010, Hospital Josep Trueta, 17007 Girona, Spain; and Departments of Epidemiology (T.P.) and Internal Medicine (J.F.), Hospital Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain

Address all correspondence and requests for reprints to: María-José Barahona, Department of Endocrinology, Hospital Mútua de Terrassa, Pl Dr Robert 5, 08221 Terrassa, Barcelona, Spain. E-mail: 33962mbc{at}comb.cat.

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 TNF-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.