Loss of Body Cell Mass in Cushing’s Syndrome: Effect of Treatment

• Published in: The journal of clinical endocrinology and metabolism Vol. 87; no. 3; pp. 1078 - 1084
• Main Authors: Pirlich, Matthias, Biering, Henrik, Gerl, Helga, Ventz, Manfred, Schmidt, Bernd, Ertl, Siegfried, Lochs, Herbert
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Copyright by The Endocrine Society 01.03.2002; Endocrine Society
• Subjects: Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Adult; Aged; Anthropometry; Biological and medical sciences; Body Composition; Cushing Syndrome - metabolism; Cushing Syndrome - pathology; Cushing Syndrome - surgery; Electric Impedance; Endocrinopathies; Female; Humans; Male; Medical sciences; Metabolic diseases; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Obesity; Pituitary Gland - surgery; Potassium - metabolism; Reference Values; Treatment Outcome; Endocrinopathy; Adrenal cortex diseases; Anthropometry; Body weight; Hyperadrenocorticism; Adenoma; Body composition; Surgery; Adrenal gland diseases; Lean body mass; Pituitary gland; Control method; Benign neoplasm; Whole body; Nutritional status; Human; Obesity; Nutrition disorder; Cushing syndrome; Protein A; Treatment; Cell death; Fat; Impedance; Potassium; Comparative study
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.87.3.1078

Cushing’s syndrome (CS) is associated with low fat-free mass, but it is unclear whether hypercortisolism causes a loss of whole body protein. Body composition was studied prospectively in 15 patients with untreated CS (n = 14 pituitary adenoma; n = 1 adrenal adenoma), in 15 nonobese healthy controls, and in 15 weight-matched obese controls by 3 different methodstotal body potassium counting (TBP), bioelectrical impedance analysis (BIA), and anthropometry. In 6 patients, body composition was studied before and within 6 months after pituitary surgery.In CS patients and weight-matched controls, body weight and total body fat were significantly higher than in nonobese controls. In CS patients, TBP was 18.4% lower than predicted, whereas in weight-matched controls TBP was 7.1% higher than predicted. As compared with nonobese and weight-matched controls, in CS patients TBP indicated a significant loss of body cell mass (BCM) of −20.2 and −21.1%, respectively. A significantly reduced arm muscle area of −21.3% compared with weight-matched controls also indicated a loss of whole body protein. In CS, however, BIA overestimated BCM when compared with TBP by +18% and agreement between BIA and TBP in the individual patient was poor (limits of agreement ± 27.6%), indicating the invalidity of standard BIA equations in this population. Measurements performed before and 6 months after successful pituitary surgery demonstrated a significant loss of body weight (−11%) and body fat (−33%), but BCM and muscle mass remained on a constant low level.In conclusion, this study shows that, in patients with CS, a significantly reduced BCM indicates a true protein loss. The second interesting finding is that in the early recovery after successful treatment of hypercortisolism patients lose body fat without gaining BCM or muscle mass.