title: Persistent centripetal fat distribution and metabolic abnormalities in patients in long-term remission of Cushing's syndrome.
abstract: OBJECTIVE
  Centripetal obesity is associated with systemic low-grade inflammation and an increased cardiovascular risk. Patients in long-term remission of Cushing's syndrome (CS) report persisting abdominal fat accumulation. However, this has previously not been adequately objectified. Therefore, we investigated the adipose tissue distribution and adipocytokine profiles of patients in long-term remission of CS.
  
  
  METHODS
  Cross-sectional case-control study in a tertiary referral centre.
  
  
  METHODS
  Fifty-eight patients, in remission of CS for at least 5 years, were compared to 58 age-, gender- and BMI-matched healthy control subjects.
  
  
  METHODS
  Measures of body composition (assessed with clinical evaluation and dual-energy X-ray absorptiometry (DEXA) scanning) and serum adipocytokine profiles.
  
  
  RESULTS
  Compared to the matched control subjects, patients in long-term remission of CS had a greater waist circumference (P < 0·01), a smaller thigh circumference (P < 0·01), a higher waist-to-hip ratio (P < 0·01) and a higher hip-to-thigh ratio (P < 0·01). As measured with DEXA scanning, patients had a higher percentage of truncal fat mass (P = 0·01), and the truncal fat mass to leg fat mass ratio was greater (P < 0·01). Patients had lower adiponectin levels (P < 0·01), higher leptin levels (P < 0·01) and higher resistin levels (P = 0·04) than control subjects.
  
  
  CONCLUSIONS
  Even after long-term remission, patients who suffered from CS in the past continue to have a centripetal adipose tissue distribution and an adverse adipokine profile. This is independent of aetiology of the CS, treatment strategies, hormonal deficiencies and comorbidity, and probably contributes to the persistent increased cardiovascular risk.
authors.affiliation: Department of Medicine, Division of Endocrinology, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Margreet
authors.initials: M
authors.lastname: Wagenmakers
authors.forename: Sean
authors.initials: S
authors.lastname: Roerink
authors.forename: Linda
authors.initials: L
authors.lastname: Gil
authors.forename: Theo
authors.initials: T
authors.lastname: Plantinga
authors.forename: Jan
authors.initials: J
authors.lastname: Smit
authors.forename: Romana
authors.initials: R
authors.lastname: Netea-Maier
authors.forename: Ad
authors.initials: A
authors.lastname: Hermus
mesh_terms: D050153:Abdominal Fat / Q000378:metabolism* / Q000473:pathology; D054392:Adipokines / Q000378:metabolism; D000328:Adult; D050218:Body Fat Distribution; D002318:Cardiovascular Diseases / Q000209:etiology / Q000378:metabolism; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003480:Cushing Syndrome / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism* / Q000534:rehabilitation*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000378:metabolism; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000453:epidemiology / Q000378:metabolism*; D012074:Remission Induction; D012307:Risk Factors; D013997:Time Factors
chemical_list: D054392:Adipokines; D005938:Glucocorticoids