Persistence of myopathy in Cushing's syndrome: evaluation of the German Cushing's Registry.
BACKGROUND
Cushing's syndrome (CS) is characterized by an excessive secretion of glucocorticoids that results in a characteristic clinical phenotype. One feature of clinical hypercortisolism is breakdown of protein metabolism translating into clinical consequences including glucocorticoid-induced myopathy. While surgery is effective in control of cortisol excess, the effect of biochemical remission on muscular function is yet unclear.


METHODS
In a cross-sectional study we analyzed 47 patients with CS during the florid phase (ActiveCS). 149 additional patients were studied 2-53 years (mean: 13 years) after surgery in biochemical long-term remission (RemissionCS). Also, 93 rule-out CS patients were used as controls (CON). All subjects were assessed for grip strength using a hand grip dynamometer and underwent the chair rising test (CRT).


RESULTS
Hand grip strength (85% vs 97% of norm,P= 0.002) and the CRT performance (9.5 s vs 7.1 s,P= 0.001) were significantly lower in ActiveCS compared to the CON group. Six months after treatment grip strength further decreased in CS (P= 0.002) and CRT performance remained impaired. The RemissionCS group (mean follow-up 13 years) had reduced hand grip strength (92% compared to normal reference values for dominant hand,P< 0.001). The chair rising test performance was at 9.0 s and not significantly different from the ActiveCS group (P= 0.45).


CONCLUSIONS
CS affects muscle strength in the acute phase, but functional impairment remains detectable also during long-term follow-up despite biochemical remission.
Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
Christina M
CM
Berr
RG NeuroendocrinologyMax Planck Institute of Psychiatry, Munich, Germany.
Mareike R
MR
Stieg
Department of Internal Medicine IDivision of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, Wuerzburg, Germany.
Timo
T
Deutschbein
Endocrinology in CharlottenburgBerlin, Germany.
Marcus
M
Quinkler
Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
Ralf
R
Schmidmaier
Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
Andrea
A
Osswald
Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
Nicole
N
Reisch
Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
Katrin
K
Ritzel
RG NeuroendocrinologyMax Planck Institute of Psychiatry, Munich, Germany.
Christina
C
Dimopoulou
Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
Julia
J
Fazel
Department of Internal Medicine IDivision of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, Wuerzburg, Germany.
Stefanie
S
Hahner
RG NeuroendocrinologyMax Planck Institute of Psychiatry, Munich, Germany.
Günter K
GK
Stalla
Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
Felix
F
Beuschlein
Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
Martin
M
Reincke
D000315:Adrenalectomy / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003480:Cushing Syndrome / Q000503:physiopathology / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D018737:Hand Strength; D020249:Hormone Replacement Therapy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000187:drug effects / Q000503:physiopathology*; D009135:Muscular Diseases / Q000139:chemically induced / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000187:drug effects; D012042:Registries; D012074:Remission Induction
D005938:Glucocorticoids