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Loss of Body Cell Mass in Cushing’s Syndrome: Effect of Treatment

Medizinische Klinik und Poliklinik (M.P., H.B., H.G., M.V., B.S., H.L.), Abteilung Gastroenterologie, Universitätsklinikum Charité, Humboldt-Universität zu Berlin D-10098, Germany; and Abteilung für Nuklearmedizin (S.E.), Klinikum Buch, D-13125 Berlin, Germany

Address all correspondence and requests for reprints to: Dr. Matthias Pirlich, Medizinische Klinik und Poliklinik, Universitätsklinikum Charité, Humboldt-Universität zu Berlin, 10098 Berlin. E-mail: . matthias.pirlich{at}charite.de

Abstract

Cushing’s syndrome (CS) is associated with low fat-free mass, but it is unclear whether hypercortisolism causes a loss of whole body protein. Body composition was studied prospectively in 15 patients with untreated CS (n = 14 pituitary adenoma; n = 1 adrenal adenoma), in 15 nonobese healthy controls, and in 15 weight-matched obese controls by 3 different methods: total body potassium counting (TBP), bioelectrical impedance analysis (BIA), and anthropometry. In 6 patients, body composition was studied before and within 6 months after pituitary surgery.

In CS patients and weight-matched controls, body weight and total body fat were significantly higher than in nonobese controls. In CS patients, TBP was 18.4% lower than predicted, whereas in weight-matched controls TBP was 7.1% higher than predicted. As compared with nonobese and weight-matched controls, in CS patients TBP indicated a significant loss of body cell mass (BCM) of -20.2 and -21.1%, respectively. A significantly reduced arm muscle area of -21.3% compared with weight-matched controls also indicated a loss of whole body protein. In CS, however, BIA overestimated BCM when compared with TBP by +18% and agreement between BIA and TBP in the individual patient was poor (limits of agreement ± 27.6%), indicating the invalidity of standard BIA equations in this population. Measurements performed before and 6 months after successful pituitary surgery demonstrated a significant loss of body weight (-11%) and body fat (-33%), but BCM and muscle mass remained on a constant low level.

In conclusion, this study shows that, in patients with CS, a significantly reduced BCM indicates a true protein loss. The second interesting finding is that in the early recovery after successful treatment of hypercortisolism patients lose body fat without gaining BCM or muscle mass.

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