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

 Namki Hong  ;  Jooyeon Lee  ;  Cheol Ryong Ku  ;  Kichang Han  ;  Cho Rok Lee  ;  Sang Wook Kang  ;  Yumie Rhee 
 Clinical Endocrinology, Vol.90(2) : 267-276, 2019 
Journal Title
 Clinical Endocrinology 
Issue Date
Cushing’s syndrome ; body composition ; hypercortisolaemia ; sarcopenia ; skeletal muscle ; visceral fat
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 tumour (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.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
강상욱(Kang, Sang Wook) ORCID logo https://orcid.org/0000-0001-5355-833X
구철룡(Ku, Cheol Ryong) ORCID logo https://orcid.org/0000-0001-8693-9630
이유미(Rhee, Yumie) ORCID logo https://orcid.org/0000-0003-4227-5638
이초록(Lee, Cho Rok) ORCID logo https://orcid.org/0000-0001-7848-3709
한기창(Han, Ki Chang) ORCID logo https://orcid.org/0000-0002-9701-9757
홍남기(Hong, Nam Ki) ORCID logo https://orcid.org/0000-0002-8246-1956
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