title: Body composition and cardiovascular risk markers after remission of Cushing's disease: a prospective study using whole-body MRI.
abstract: BACKGROUND
  Cushing's Disease (CD) alters fat distribution, muscle mass, adipokine profile, and cardiovascular risk factors. It is not known whether remission entirely reverses these changes.
  
  
  OBJECTIVE
  Our objective was to determine whether the adverse body composition and cardiovascular risk profile in CD change after remission.
  
  
  METHODS
  Fourteen CD patients were studied prospectively: before surgery (active disease) and again postoperatively 6 months after discontinuing oral glucocorticoids (remission). Whole-body magnetic resonance imaging was used to examine lean and fat tissue distributions.
  
  
  METHODS
  Body composition (skeletal muscle and fat in the visceral, bone marrow, sc, and inter-muscular compartments) and cardiovascular risk factors (serum insulin, glucose, leptin, high-molecular-weight adiponectin, C-reactive protein, and lipid profile) were measured in active CD and remission (mean 20 months after surgery).
  
  
  RESULTS
  Remission decreased visceral, pelvic bone marrow, sc (including trunk and limb sc), and total fat; waist circumference; and weight (P < 0.05). Remission altered fat distribution, resulting in decreased visceral/total fat (P = 0.04) and visceral fat/skeletal muscle ratios (P = 0.006). Remission decreased the absolute muscle mass (P = 0.015). Cardiovascular risk factors changed: insulin resistance, leptin, and total cholesterol decreased (P < 0.05), but adiponectin, C-reactive protein, and other lipid measures did not change.
  
  
  CONCLUSIONS
  CD remission reduced nearly all fat depots and reverted fat to a distribution more consistent with favorable cardiovascular risk but decreased skeletal muscle. Remission improved some but not all cardiovascular risk markers. Remission from CD dramatically improves body composition abnormalities but may still be associated with persistent cardiovascular risk.
authors.affiliation: Department of Medicine, Division of Endocrinology, Mount Sinai School of Medicine, One Gustave Levy Place, Box 1055, New York, New York 10029, USA. eliza.geer@mssm.edu
authors.forename: Eliza B
authors.initials: EB
authors.lastname: Geer
authors.forename: Wei
authors.initials: W
authors.lastname: Shen
authors.forename: Erika
authors.initials: E
authors.lastname: Strohmayer
authors.forename: Kalmon D
authors.initials: KD
authors.lastname: Post
authors.forename: Pamela U
authors.initials: PU
authors.lastname: Freda
mesh_terms: D052242:Adiponectin / Q000097:blood; D000273:Adipose Tissue / Q000378:metabolism*; D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D001786:Blood Glucose; D001823:Body Composition / Q000502:physiology*; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000209:etiology / Q000378:metabolism*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology; D020738:Leptin / Q000097:blood; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000378:metabolism; D047748:Pituitary ACTH Hypersecretion / Q000188:drug therapy / Q000378:metabolism* / Q000601:surgery; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors
chemical_list: D052242:Adiponectin; D015415:Biomarkers; D001786:Blood Glucose; D005938:Glucocorticoids; D007328:Insulin; D020738:Leptin; D002097:C-Reactive Protein