Abnormal body composition in patients with adrenal adenomas

Abstract

Objective: Increased visceral fat and sarcopenia are cardiovascular risk factors that may explain increased cardiovascular morbidity and frailty in patients with adrenal adenomas. Our objective was to compare body composition measurement of patients with adrenal adenomas to referent subjects without adrenal disease Design: Cross-sectional study, 2014-2018 Methods: Participants were adults with nonfunctioning adrenal tumor (NFAT), mild autonomous cortisol secretion (MACS) and Cushing syndrome (CS), and age, sex and body mass index 1:1 matched referent subjects without adrenal disorders. Main outcome measures were body composition measurements calculated from abdominal computed tomography imaging. Intraabdominal adipose tissue and muscle mass measurements were performed at the 3rd lumbar spine level. Results: Of 227 patients with adrenal adenomas, 20 were diagnosed with CS, 76 with MACS and 131 with NFAT. Median age was 56 years (range, 18-89), and 67% were women. When compared to referent subjects, patients with CS, MACS, and NFAT demonstrated a higher visceral fat (odds ratio (OR) of 2.2 [95% CI 0.9-6.5], 2.0 [1.3-3.2], and 1.8 [1.2-2.7] and a lower skeletal muscle area (OR of 0.01 [95% CI 0-0.09], 0.31 [0.18-0.49], and 0.3 [1.2-2.7]), respectively. For every 1 mcg/dL cortisol increase after overnight dexamethasone, visceral fat/muscle area ratio increased by 2.3 (P=0.02) and mean total skeletal muscle area decreased by 2.2cm2 (P=0.03). Conclusion: Patients with adrenal adenomas demonstrate a lower muscle mass and a higher proportion of visceral fat when compared to referent subjects, including patients with NFAT. Even a subtle abnormality in cortisol secretion may impact health of patients with adenomas.

Cardiovascular risk factors in mild adrenal autonomous cortisol secretion in a Caucasian population

“…We observed MACS in 15.2% of patients without T2DM, in comparison to 29.5% in subjects with T2DM. It should be mentioned that Delivanis et al did not observe significant differences in T2DM or impaired glucose tolerance between patients with and without MACS ( 24 ). In our study, we did not find differences in PD between MACS and NFAT and we did not observe differences in the frequency of impaired fasting glucose and impaired glucose tolerance in patients with MACS.…”

“…To the contrary, in the study conducted by Delivanis et al, it was reported that patients with MACS had a higher prevalence of dyslipidaemia when compared to those with NFAT (67% vs. 47%) (24). Interestingly, in the last systemic meta-analysis and review, it was shown that dyslipidaemia is present in 34.1% of patients with MACS and in 33.8% of those with NFAT (17).…”

“…In the last meta-analysis, hypertension was more frequently found in MACS than in NFAT (64.0% vs. 58.2%) (17). Interestingly, Delivanis et al did not observe significant differences in hypertension or T2D between patients with Cushing's syndrome, MACS, and NFAT (24). Therefore, there is ongoing debate as to whether these diseases are associated with an increased risk of cardiovascular disease in MACS in comparison to NFAT.…”

Glucose and lipid metabolism abnormalities in Cushing's syndrome

“…For every 1 μg dL À1 (28 nmoL L À1 ) increase in cortisol levels after overnight dexamethasone, the visceral fat/muscle area ratio significantly increases by 2.3%. 35 Patients with Cushing's syndrome also develop ectopic fat deposition. Increased epicardial and pericardial fat accumulation was observed without myocardial steatosis, whereas bone marrow also showed increased adiposity.…”

Pathophysiology of Mild Hypercortisolism: From the Bench to the Bedside

“…Interestingly, for every 1 µg/dL cortisol increase after DST, the visceral fat/muscle area ratio significantly increased by 2.3 times, and the mean total skeletal muscle area significantly decreased by 2.2 cm 2 . These data not only suggest that, similarly to Cushing’s syndrome patients, mHC patients are at risk of sarcopenia but also show that, at least as far as skeletal muscle is concerned, the DST cutoff set at 1.8 μg/dL is not sensitive enough to identify AI patients at risk for sarcopenia [ 117 ]. One year after adrenalectomy, skeletal muscle density measured by computed tomography was found to ameliorate, and in a multivariate linear regression model, the increase by 1 μg/dL of cortisol after DST measured before surgery was independently associated with greater reduction in visceral fat area and of visceral fat/subcutaneous fat ratio after surgery [ 118 ].…”