CHANGES IN BODY-COMPOSITION AND ADIPOSE-TISSUE DISTRIBUTION AFTER TREATMENT OF WOMEN WITH CUSHINGS-SYNDROME

Longitudinal studies on changes in body composition and adipose tissue (AT) distribution in response to altered cortisol exposure have not y et been undertaken. Therefore, we determined body composition in seven women aged 34 +/- 9 years (mean +/- SD) with Gushing's disease/syndro me before and 8 +/- 2 (SD) months after surgical treatment for pituita ry (n = 5) or cortical adrenal (n = 2) adenomas. The treatment resulte d in a reduction of plasma and urinary cortisol by 78% and 97% (P < .0 1), respectively, and body weight (BW) reductions of 10.2 +/- 8.1 (SD) kg. The volumes of AT, skeletal muscle plus skin, and visceral organs were determined using a multiscan computed tomography (CT) technique. Organ and tissue volumes were converted to weight by multiplying with organ densities. After treatment, AT was reduced by 8.2 +/- 6.1 kg (P = .012), skeletal muscle plus skin by 1.3 +/- 1.7 kg (NS), and viscer al organs by 0.6 +/- 1.0 kg (NS). The net change of AT, skeletal muscl e plus skin, and visceral organs (Delta AMV) was thus -10.1 +/- 7.8 kg , which was in good agreement with the change in BW (Delta BW, -10.2 /- 8.1 kg). The standard error of a single determination calculated on the differences between Delta BW and Delta AMV was 2.8%. Although tot al skeletal muscle plus skin was not changed, muscle of arms was reduc ed by 0.3 +/- 0.2 L (P = .014). Except for leg AT (P = .088), the redu ctions of all regional AT depots (arms, head + neck, subcutaneous trun k, visceral were significant when expressed in liters. The total AT wa s reduced by 23% +/- 11%. When expressed as a percentage of initial de pot volumes, the reductions were unevenly distributed. Thus, AT of vis cera and head + neck were reduced by 34% to 36%, AT of subcutaneous tr unk by 26%, and AT of arms and legs by 18% and 8%, respectively. A cha nged AT distribution was demonstrated by expressing each AT depot as a percentage of the total AT volume both before and after treatment. Af ter treatment, AT of legs was increased by 4.2% units, which was signi ficantly different from the reductions in visceral AT (2.5% units) and subcutaneous trunk AT (1.8% units; F = 5.29, P = .002). Changes in mu scle distribution did not reach significance. From the alterations in body composition observed after normalization of a hypercortisolic sta te, it is concluded that cortisol directly or indirectly increases the total mass of AT and redistributes AT from peripheral to visceral dep ots.