Glucocorticoid-Induced Hypermetabolism in White Adipose Tissue in Cushing Syndrome

Abstract

An adult lymphoma patient developed Cushing syndrome after short-term, high-dose dexamethasone administration and presented with a distinctive Cushingoid fat redistribution pattern and associated increased 18 F-FDG uptake in white adipose tissue. Recognition of the unique 18 F-FDG uptake manifestation may aid in the diagnosis of this iatrogenic syndrome and avoid image misinterpretation.

White adipose tissue uptake on 18F FDG PET/CT: A case report

“…BAT uptake can be localized predominantly to the supraclavicular, axillary, and cervical regions, in comparison, WAT has been found to be localized more peripherally in the face and torso regions predominantly [ 4 , 6 ].…”

“…This phenomenon has been associated to medication, primarily high-dose corticosteroids used for chemotherapy, external steroid use, and secondarily to hypoglycemia [4] . This rare association has been attributed to the effect steroids have on catabolic lipolysis, anabolic lipogenesis, and adipogenesis, which consequently release free fatty acids and are pro-inflammatory, producing an increase in glycolytic metabolism in the mitochondria which can induce glucose uptake during FDG PET/CT studies [4] , [5] , [6] , [7] . This altered biodistribution can obscure active disease as there is decreased uptake in the blood pool, as seen on our case, and as thus, decreased uptake within the disease and its metastatic lesions [4] .…”

“…Additional causes, including exogenous corticosteroid use, anti-retroviral medications as well as herbal remedies, have been identified [4] . Despite diverse etiologies, altered biodistribution tends to manifest predominantly in subcutaneous and visceral fat deposits pertaining to WAT, often affecting regions such as the face, neck and back [ 4 , 6 , 7 ].…”

FDG altered biodistribution in white adipose tissue, a rare entity: case report and review of the literature

“…The lipolysis, lipogenesis, and adipogenesis needed to create a Cushingoid distribution of white adipose tissue were hypothesized to contribute to this pattern of uptake Hwang, Catholic Kwandong University College of Medicine, Korea (2016) (Hwang et al 2016 ) 1 (1) 61-year-old woman with diffuse large B-cell lymphoma Abnormal FDG biodistribution was hypothesized to be due to the prednisone given during R-CHOP treatment or herbal treatments that contain corticosteroids Kong, British Columbia Children's Hospital, Canada (2018) (Kong and Nadel 2018 ) 1 (1) 9-year-old girl with chronic Epstein-Barr virus infection Chronic corticosteroid treatment was thought to be the cause of altered FDG biodistribution Caton, Brigham and Women's Hospital, USA (2018) (Caton et al 2018 ) 1 (0) 62-year-old man with HIV on HAART Diffuse FDG localization to subcutaneous and visceral fat was found to be consistent with HIV-associated lipodystrophy Wong, C. S. Mott Children’s Hospital, USA (2020) (Wong et al 2020 ) 13 (8) Children and young adults (range: 7–23 years old), most of whom were diagnosed with leukemia or lymphoma except one patient diagnosed with Ewing sarcoma and another patient diagnosed with neuroblastoma All identified patients with altered biodistribution received induction treatment which included corticosteroids. Areas of active disease were obscured by white fat activity, and repeat imaging one week later resulted in relatively normalized biodistribution sufficient to detect previously hidden lesions Staack, Mayo Clinic, Arizona, USA (2020) (Staack et al 2020 ) 1 (1) 59-year-old woman with lymphoma In addition to chemotherapy, her treatment regimen also included dexamethasone to prevent cerebral edema. Therefore, altered FDG biodistribution was ascribed to glucocorticoid-induced Cushing syndrome Young, Yale New Haven Hospital, USA (2021) (Young et al 2021 ) 1 (0) 13-year-old boy with T-cell lymphoblastic lymphoma Although the patient received high dose corticosteroids with induction chemotherapy, the authors hypothesized that L-asparaginase, which was administered only three hours prior to FDG-PET/CT, may have been responsible for diffuse white adipose uptake Kapoor, University of Kentucky Chandler Medical Center, USA (2021) (Kapoor et al 2...…”

Effects of natural products on skin inflammation caused by abnormal hormones secreted by the adrenal gland

“…Curcumin shows antitumor, antioxidant, and anti-inflammatory properties ( Aggarwal and Harikumar, 2009 ; Walker and Mittal, 2020 ; Mahjoob and Stochaj, 2021 ). Hormone abnormalities of adrenal gland are the major cause leading to Cushing’s syndrome ( Staack et al, 2020 ; Uehara et al, 2020 ), Addison’s disease ( Jabbour, 2003 ; Nieman and Chanco Turner, 2006 ). Hormone abnormalities of adrenal gland can also induce skin inflammation including acne ( Nikolakis et al, 2016 ), skin atrophy ( Schoepe et al, 2006 ), bruising ( Niculet et al, 2020 ), hyperpigmentation ( Benner et al, 2019 ), hirsutism ( Bienenfeld et al, 2019 ), androgenetic alopecia ( Alesci and Bornstein, 2000 ).…”