title: Visceral fat accumulation and postdexamethasone serum cortisol levels in patients with adrenal incidentaloma.
abstract: OBJECTIVE
  Visceral fat is a significant cardiovascular risk factor. Because visceral fat has not been measured systematically in patients with adrenal incidentalomas, we have tested the hypothesis that visceral fat volume may be associated with cutoffs for serum cortisol levels post dexamethasone.
  
  
  METHODS
  This was a retrospective, cross-sectional study.
  
  
  METHODS
  The study was conducted at the Endocrine Investigation Unit, University Teaching Hospital.
  
  
  METHODS
  Seventy-three women and 52 men diagnosed with adrenal incidentalomas and 9 patients with overt Cushing's syndrome participated in this study.
  
  
  METHODS
  The following was measured for serum cortisol level after dexamethasone suppression and visceral fat ratios: visceral-subcutaneous (V:S) and visceral-total volume (V:TV) measured by computed tomography.
  
  
  RESULTS
  Sixty-eight patients with a postdexamethasone serum cortisol greater than 1.8 μg/dL (50 nmol/L) showed a significantly higher mean V:S and V:TV fat ratio compared with those whose serum cortisol was less than 1.8 μg/dL: women, lnV:S, -0.45 vs -0.69 [mean difference 0.24 (95% confidence interval [CI] 0.08-0.41); P = .004] and V:TV, 0.39 vs 0.34 [mean difference 0.05 (95% CI 0.02-0.09); P = .004]; men, lnV:S, 0.64 vs 0.29 [mean difference 0.35 95% CI 0.08-0.63); P = .01] and V:TV, 0.65 vs 0.57 [mean difference 0.08 (95% CI 0.02-0.14); P = .02]. By ANOVA and post hoc analysis (Fisher's least significant differences), there was no difference in fat ratios between the postdexamethasone serum cortisol groups [1.8-2.9 μg/dL (50-82 nmol/L), 3.0-5.0 μg/dL (83-137 nmol/L), > 5.0 μg/dL (>138 nmol/L) and Cushing's syndrome (mean V:TV: 0.38, 0.40, 0.40, 0.41, respectively)], but they all differed significantly from the less than the 1.8-μg/dL group (V:TV: 0.34, P = .03).
  
  
  CONCLUSIONS
  Visceral fat is increased in patients with adrenal incidentalomas and a postdexamethasone serum cortisol of greater than 1.8 μg/dL and is similar to that found in patients with overt Cushing's syndrome.
authors: Department of Human Metabolism, School of Medicine and Biomedical Science, Beech Hill Road, University of Sheffield, Sheffield S10 2RF, United Kingdom.
authors: Miguel
authors: M
authors: Debono
authors: Anna
authors: A
authors: Prema
authors: Timothy J B
authors: TJ
authors: Hughes
authors: Matthew
authors: M
authors: Bull
authors: Richard J
authors: RJ
authors: Ross
authors: John
authors: J
authors: Newell-Price
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000378:metabolism*; D000368:Aged; D003430:Cross-Sectional Studies; D003480:Cushing Syndrome / Q000378:metabolism; D003907:Dexamethasone / Q000494:pharmacology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D050152:Intra-Abdominal Fat / Q000378:metabolism*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D003907:Dexamethasone; D006854:Hydrocortisone