Changes in body composition and adipose tissue distribution after treatment of women with Cushing's syndrome

Abstract Longitudinal studies on changes in body composition and adipose tissue (AT) distribution in response to altered cortisol exposure have not yet been undertaken. Therefore, we determined body composition in seven women aged 34 ± 9 years (mean ± SD) with Cushing's disease/syndrome before and 8 ± 2 (SD) months after surgical treatment for pituitary (n = 5) or cortical adrenal (n = 2) adenomas. The treatment resulted in a reduction of plasma and urinary cortisol by 78% and 97% ( P P = .012), skeletal muscle plus skin by 1.3 ± 1.7 kg (NS), and visceral organs by 0.6 ± 1.0 kg (NS). The net change of AT, skeletal muscle plus skin, and visceral organs (ΔAMV) was thus −10.1 ± 7.8 kg, which was in good agreement with the change in BW (ΔBW, −10.2 ± 8.1 kg). The standard error of a single determination calculated on the differences between ΔBW and ΔAMV was 2.8%. Although total skeletal muscle plus skin was not changed, muscle of arms was reduced by 0.3 ± 0.2 L ( P = .014). Except for leg AT ( P = .088), the reductions of all regional AT depots (arms, head + neck, subcutaneous trunk, viscera) were significant when expressed in liters. The total AT was reduced by 23% ± 11%. When expressed as a percentage of initial depot volumes, the reductions were unevenly distributed. Thus, AT of viscera and head + neck were reduced by 34% to 36%, AT of subcutaneous trunk by 26%, and AT of arms and legs by 18% and 8%, respectively. A changed AT distribution was demonstrated by expressing each AT depot as a percentage of the total AT volume both before and after treatment. After treatment, AT of legs was increased by 4.2% units, which was significantly different from the reductions in visceral AT (2.5% units) and subcutaneous trunk AT (1.8% units; F = 5.29, P = .002). Changes in muscle distribution did not reach significance. From the alterations in body composition observed after normalization of a hypercortisolic state, it is concluded that cortisol directly or indirectly increases the total mass of AT and redistributes AT from peripheral to visceral depots.