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Persistent Body Fat Mass And Inflammatory Marker Increases After Long-Term Cure Of Cushing's Syndrome

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Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2009-0766


Mar?a-Jos? Barahona*, Nuria Sucunza, Eugenia Resmini, Jos?-Manuel Fern?ndez-Real, Wifredo Ricart, Jos?-Mar?a Moreno-Navarrete, Teresa Puig, Jordi Farrerons, and Susan M. Webb


Endocrinology and Medicine Departments and Centro de Investigaci?n Biom?dica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Hospital Sant Pau, Universitat Aut?noma de Barcelona; Endocrinology Department, Institut d'Investigaci? Biom?dica de Girona (IDIBGI) and CIBER Fisiopatologia de la Obesidad y Nutrici?n CB06/03/010; Hospital Josep Trueta, Girona; Epidemiology and Internal Medicine Departments, Hospital Sant Pau, Universitat Aut?noma de Barcelona, Spain


* To whom correspondence should be addressed. E-mail: 33962mbc@comb.cat.


Objective: Although increased central fat mass is characteristic of active Cushing's syndrome (CS), little is known on body composition and secretion of adipokines after long-term recovery of CS. The aim was to evaluate central fat mass and its correlation with adipokines and cardiovascular risk factors in patients after long-term remission of CS.


Methods: Thirty-seven women with CS in remission (27 of pituitary and 10 of adrenal origin, mean age: 50 ? 14 years, mean time of hormonal cure: 11 ? 6 years) were enrolled and compared to 14 with active CS and 85 gender, age and BMI-matched healthy controls. Total and trunk fat mass were measured by dual-energy x-ray absorptiometry scanning. Laboratory parameters and adipokine levels [including adiponectin, visfatin, soluble TNF{alpha}-receptor 1 (sTNF-R1), sTNF-R2 and IL-6] were measured.


Results: Cured CS patients had more total and trunk fat mass than controls. Cured and active CS had higher levels of sTNF-R1 and IL-6, and lower adiponectin levels than controls. Higher insulin levels and blood pressure in both groups of CS patients and higher apoprotein B in cured CS were observed compared to controls. sTNF-R1 correlated positively with percentage of trunk fat mass, and remained significant after adjusting for anthropometric parameters.


Conclusion: Despite long-term cure, patients who have suffered CS exhibit persistent accumulation of central fat, as in active hypercortisolemia, with the consequent unfavourable adipokine profile, leading to a state of low-grade inflammation. This situation determines a persistent and increased cardiovascular risk in these patients.



Key words: Cushing's syndrome ? fat mass ? inflammation



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I wonder if one of the weak points in the study is the 27 post-op pit patients were in remission. I wonder how many of those subjects were really in remission.


I wish they did the study with BLA patients only. Any BLA'ers on here agree with the findings? Do you still have belly fat?


Anyone familiar with those receptors they mentioned?

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I lost most of the belly fat (before I got preggers lol!) but stil have spare skin (copious amounts of it!) and a pocket of fat that I just know will not go away without surgery - the apron that hangs down with the spare skin is where that fat pocket is. :(


I think that because of the way the fat is distributed with Cushings that it would be very difficult to get rid of it all - there's only so many stomach-crunches you can do in a day! So I suppose that I do agree with the article, unfortunately.


I have no idea what those receptors are that were mentioned.

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I agree with Tasia...I wonder how many of the cured really were.


I've had a bla and have lost 50 pounds, half my weight. Just by looking at the way things are starting to hang though, I'm quite sure I'll need a tummy-tuck to get rid of the excess skin.


I'm not sure what to think of the high inflammation marker---sigh.



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I wonder if 'we' could write a letter to the editor like other medical practitioners do asking these questions.


Why not?


Maybe they would separate out the bla-ers. Or maybe the answer is in the full article and I couldn't get to it.

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I'm curious if anyone with a weight gain of 30-40 pounds or less has ever been able to lose the central adipose tissue completely and go back to their pre-Cushing's state. I know I've read bios of people who started out a size 6 and maybe went to a 10-12. I gained at least 55 pounds with each of my pregnancies and was able to lose the abdominal fat. I have pictures of me in a bikini after my first.


Just before I read this article, I was looking at my swollen belly and thinking that I still look just as Cushie as before surgery, which was unilateral adrenalectomy Dec. 2007. I hate this. I still look pregnant. I'm considering liposuction after reading that piece. If it si not going to come off, I may as well do it sooner than later.


Also, would people mind posting their ages. I'm trying to determine if I'm doomed, as I'm 55yo and was cast into surgical menopause.


The BLA suggestion was a good one.


After a few more suggestions, someone technically inclined should start a poll.


Sorry, but this is a sore point lately. I've been at the gym for hours every week for six months and have not lost any weight, nor any abdominal weight. I look pregnant, and I'm sick of it. I'm going to the Endo in two days, and he will get an earful...Maybe, this is why he told me I wouldn't lose the Cushie stomach last year.



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