A prospective study of appetite and food craving in 30 patients with Cushing's disease.
BACKGROUND
Glucocorticoid (GC) exposure increases food intake, but the mechanisms in humans are not known. Investigation of appetite and food craving has not been done in patients with chronic GC exposure due to Cushing's disease (CD), either before or after treatment, and could provide insight into mechanisms of food intake and obesity in these patients.


OBJECTIVE
To examine whether surgical remission of CD changes appetite (prospective consumption, hunger, satisfaction, and fullness) and food cravings (sweet, salty, fatty, and savory); and to identify predictors of appetite and craving in CD remission.


METHODS
30 CD patients, mean age 40.0 years (range 17-70), mean BMI 32.3 ± 6.4, were prospectively studied before and at a mean of 17.4 mo. after remission. At each visit fasting and post-test meal (50% carbohydrate, 35% protein, 15% fat) appetite and craving scores were assessed.


RESULTS
Remission decreased prospective consumption, sweet and savory craving (p < 0.05), but did not change hunger, satisfaction, fullness, or fat craving, despite decreases in BMI and fat mass. In CD remission, serum cortisol predicted lower satisfaction and fullness, and masses of abdominal fat depots predicted higher hunger and consumption (p < 0.05).


CONCLUSIONS
Chronic GC exposure in CD patients may stimulate the drive to eat by enhancing craving, rather than regulating the sensation of hunger. Continued alterations in appetite regulation due to abdominal fat mass and circulating cortisol could play a role in the cardiovascular and metabolic risk that has been reported in CD patients despite remission.
Department of Medicine, Division of Endocrinology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1055, New York, NY, 10029, USA. eliza.geer@mssm.edu.|Department of Neurosurgery, Mount Sinai Medical Center, New York, NY, 10029, USA. eliza.geer@mssm.edu.
Eliza B
EB
Geer
Department of Neurosurgery, Mount Sinai Medical Center, New York, NY, 10029, USA.
Yelena
Y
Lalazar
Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
Lizette M
LM
Couto
Department of Neurosurgery, Mount Sinai Medical Center, New York, NY, 10029, USA.
Vanessa
V
Cohen
Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
Lianna R
LR
Lipton
Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
Wei
W
Shi
Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
Emilia
E
Bagiella
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA.
Irene
I
Conwell
Department of Neurosurgery, Mount Sinai Medical Center, New York, NY, 10029, USA.
Joshua
J
Bederson
Department of Neurosurgery, Mount Sinai Medical Center, New York, NY, 10029, USA.
Jane
J
Kostadinov
Department of Neurosurgery, Mount Sinai Medical Center, New York, NY, 10029, USA.
Kalmon D
KD
Post
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA.
Pamela U
PU
Freda
D000293:Adolescent; D000328:Adult; D000368:Aged; D001066:Appetite / Q000502:physiology*; D001823:Body Composition / Q000502:physiology; D066249:Craving / Q000502:physiology*; D004435:Eating / Q000502:physiology / Q000523:psychology; D005260:Female; D005502:Food; D005518:Food Preferences / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D047748:Pituitary ACTH Hypersecretion / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology / Q000601:surgery; D011379:Prognosis; D055815:Young Adult
Appetite; Body composition; Cortisol; Cushing’s disease; Glucocorticoids