A prospective study of appetite and food craving in 30 patients with Cushing’s disease

Abstract

Context Glucocorticoid (GC) exposure increases food intake, but the mechanisms in humans are not known. Investigation of appetite and food craving has not been done in patients with chronic GC exposure due to Cushing’s disease (CD), either before or after treatment, and could provide insight into mechanisms of food intake and obesity in these patients. Purpose To examine whether surgical remission of CD changes appetite (prospective consumption, hunger, satisfaction, and fullness) and food cravings (sweet, salty, fatty, and savory); and to identify predictors of appetite and craving in CD remission. Methods 30 CD patients, mean age 40.0 yr. (range 17–70), mean BMI 32.3 ± 6.4, were prospectively studied before and at a mean of 17.4 mo. after remission. At each visit fasting and post-test meal (50% carbohydrate, 35% protein, 15% fat) appetite and craving scores were assessed. Results Remission decreased prospective consumption, sweet and savory craving (p<0.05), but did not change hunger, satisfaction, fullness, or fat craving, despite decreases in BMI and fat mass. In CD remission, serum cortisol predicted lower satisfaction and fullness, and masses of abdominal fat depots predicted higher hunger and consumption (p<0.05). Conclusions Chronic GC exposure in CD patients may stimulate the drive to eat by enhancing craving, rather than regulating the sensation of hunger. Continued alterations in appetite regulation due to abdominal fat mass and circulating cortisol could play a role in the cardiovascular and metabolic risk that has been reported in CD patients despite remission.

Associations among sugar sweetened beverage intake, visceral fat, and cortisol awakening response in minority youth

“…Treatment with exogenous glucocorticoids has been shown to increase food intake [48], and chronic glucocorticoid exposure has been related to increased palatable food intake[49, 50], in particular from sweet foods compared to savory foods [51]. In pathological glucocorticoid exposure, seen in Cushing’s disease, patients exhibited increased sweet craving and decreased post meal satiation [52]. Furthermore, patients with Cushing’s Disease, VAT was associated with increased post meal hunger[52], also indicating a relationship between dietary consumption cortisol and VAT.…”

“…In pathological glucocorticoid exposure, seen in Cushing’s disease, patients exhibited increased sweet craving and decreased post meal satiation [52]. Furthermore, patients with Cushing’s Disease, VAT was associated with increased post meal hunger[52], also indicating a relationship between dietary consumption cortisol and VAT. The current findings may be modeling a sweet preference due to elevated cortisol.…”

Glucocorticoids, stress and eating: The mediating role of appetite‐regulating hormones

“…However, evidence is inconclusive so far and especially studies regarding long‐term glucocorticoid exposure in humans are missing. One study in former CS patients revealed no change in PYY levels after remission, but unfortunately the study did not include a healthy control group 142 …”

Involvement of Ghrelin Dynamics in Stress-Induced Eating Disorder: Effects of Sex and Aging

“…High circulating ACTH levels reduce flavor cravings, and high cortisol levels reduce postprandial satisfaction and satiety in patients with Cushing's syndrome. However, there seems to be no difference in hunger, fullness, and satisfaction between the fasting and fed conditions [118]. Fasting and postprandial circulating ghrelin levels are increased in those with Cushing's syndrome because glucocorticoids stimulate the expression of ghrelin and its receptor [119][120][121].…”