Changes of computed tomography‐based body composition after adrenalectomy in patients with endogenous hypercortisolism

Summary

Context

Data on longitudinal changes of computed tomography (CT)‐determined visceral fat area (VFA), skeletal muscle area (SMA), and skeletal muscle radiodensity (SMD) after adrenalectomy are limited in patients with hypercortisolism.

Objective

To examine the association of severity of cortisol excess and improvement of CT‐based muscle and fat parameters after adrenalectomy.

Design

Retrospective observational cohort study.

Patients

One‐hundred‐thirty‐four patients with overt Cushing's syndrome (CS; n=39), mild autonomous cortisol excess (MACE; n=57), or nonfunctioning adrenal tumor (NFAT; n=38) at a tertiary endocrinology institution between 2006 and 2017 were included.

Measurements

Changes in CT‐determined VFA, visceral‐to‐subcutaneous fat ratio (VSR), SMA, skeletal muscle index (SMI), and SMD measured at the third lumbar vertebra (L3)

Results

At baseline, CS patients had higher VFA, lower SMA, SMI, and SMD values, compared to NFAT or MACE patients. Compared to NFAT, significant decreases in VFA and increases in SMA, SMI, and SMD was observed in CS 1 year after adrenalectomy. In MACE, adjusted mean changes of SMD but not VFA, SMA, or SMI differ significantly compared to NFAT (+8.9% vs. ‐3.4%, P=0.032). In a multivariate linear regression model, the increase by 1 μg/dL of post‐dexamethasone serum cortisol at baseline was independently associated with greater reduction of VFA (‐3.95%), VSR (‐3.07%), and increase in SMD (+0.92%, P<0.05 for all) after adrenalectomy.

Conclusions

The severity of cortisol excess was associated with greater improvement of L3 VFA, VSR, and SMD 1 year after adrenalectomy. These CT‐based markers may allow more objective assessment of treatment benefit at earlier stage.

This article is protected by copyright. All rights reserved.

https://ift.tt/2zciVjI