Remission of Cushing’s disease may improve body composition, reduce cardiovascular risk markers

Posted on April 5, 2012 by MaryO

Geer EB.  J Clin Endocrin Metab.2012;doi:10.1210/jc.2011-3123.

Patients in remission of Cushing’s disease may experience decreased total fat and improved cardiovascular risk factors, according to data from a prospective study.   

Researchers examined 14 participants (12 women, 2 men) with active Cushing’s disease before transsphenoidal surgery and 6 to 8 months after glucocorticoids (remission), using whole-body MRI to pinpoint patients’ lean and fat distributions. One patient required two transsphenoidal surgeries before entering remission.

Of the 14 participants, 13 had hypertension, which was confirmed by a resting blood pressure higher than 140/90 mm Hg or the use of antihypertensive medications. At follow-up, only three participants had persistent hypertension.

Most participants remained in the overweight (BMI >25 ) or obese (BMI >30) category.

Eliza B. Geer, MD, researcher for the division of endocrinology at the Mount Sinai School of Medicine, and colleagues, investigated the link between body composition and CV risk in the altered bodies of patients with Cushing’s disease.

According to the study, remission decreased visceral, pelvic bone marrow, subcutaneous (including trunk and limb) and total fat; waist circumference; and weight (P<.05). The researchers found that remission altered fat distribution, which resulted in decreased visceral/total fat (P=.04) and visceral fat/skeletal muscle ratios (P=.006). In addition, CV risk factors such as insulin resistance, leptin and total cholesterol decreased (P<.05).

“Prospective studies of CD [Cushing’s disease] are needed to understand possible associations between previous or persistent abnormalities in adipose tissue distribution and cardiovascular risk markers in patients successfully treated for CD [Cushing’s disease],” the researchers wrote.

Further studies are needed to examine the lack of change in adiponectin, C-reactive protein and other lipid measures.            

Disclosure: The researchers report no relevant financial disclosures.

 

 

Cushing’s disease alters fat distribution, muscle mass, adipokine profile and increases cardiovascular risk factors (serum insulin, glucose, leptin, high-molecular-weight adiponectin, C-reactive protein and lipid profile). Even though only a small group of 14 patients were studied, this is difficult to overcome in a rare disease like this.

They demonstrate that even though disease remission reduced most fat depots, dramatically improving body composition abnormalities, not all CV risk markers normalized completely; namely, adiponectin, C-reactive protein, and some lipid measures did not change after control of hypercortisolism. Furthermore, a decrease in skeletal muscle also persisted. This is interesting since one of the main complaints in patients “successfully” treated for Cushing’s disease is tiredness and fatigability, which persist beyond 1 year after surgery. This limits the patient’s exercise capacity and negatively affects their everyday life and subjective feeling of well-being, impairing their health-related quality of life.

Susan M. Webb, MD, PhD
Professor, Department of Medicine/Endocrinology
CIBER-ER, Unit 747 on Pituitary Diseases Hospital de Sant Pau
Universitat Autònoma de Barcelona, Spain

 

From http://www.endocrinetoday.com/view.aspx?rid=96175

 

 

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Without a shadow of a doubt.

Posted on April 5, 2012 by MaryO

Without a shadow of a doubt.

…So I will say this to anyone reading who is in the same situation that I was: Don’t give up. Stay strong. If you know in your heart that something is wrong, keep pushing until you figure out what it is. Be calm, be implacable, be willing to listen and to accept hypotheses. Take the tests you’re offered, even if you don’t agree that you need them – they might throw up something useful. Be assertive but not aggressive. And don’t ever quit…”

Great post on the difficulties of getting a diagnosis. The author is participating in the Cushing’s Awareness Challenge by request. She doesn’t have Cushing’s but is hypopituitary.

via Without a shadow of a doubt..

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Day Five, Cushing’s Awareness Challenge

Posted on April 5, 2012 by MaryO

 

The above is the official Cushing’s path to a diagnosis but here’s how it seems to be in real life:

 

 

Egads!  I remember the naive, simple days when I thought I’d give them a tube or two of blood and they’d tell me I had Cushing’s for sure.

Who knew that diagnosing Cushing’s would be years of testing, weeks of collecting every drop of urine, countless blood tests, many CT and MRI scans…

Then going to NIH, repeating all the above over 6 weeks inpatient plus an IPSS test, an apheresis (this was experimental at NIH) and specialty blood tests…

The path to a Cushing’s diagnosis is a long and arduous one but you have to stick with it if you believe you have this Syndrome.

 

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Day Four, Cushing’s Awareness Challenge

Posted on April 4, 2012 by MaryO

The Seven Dwarves of Cushing's

So, these are only seven of the many, many symptoms of Cushing’s.  I had those above – and I often felt like I looked like one of those little bearded dwarves.

Cushing’s affects every part of the body.  It’s not like when I had kidney cancer and only the kidney was affected.

Here’ are some of the many areas affected.

  • Progressive obesity and skin changes
  • Weight gain and fatty tissue deposits, particularly around the midsection and upper back, in the face (moon face) and between the shoulders (buffalo hump). Some symptoms such as sudden weight gain, are caused by excess cortisol. The excess cortisol in the body does not increase protein and carbohydrate metabolism. It slows or nearly disables metabolism function, which can cause weight gain (fat accumulation) in the buttocks, abdomen, cheeks, neck, or upper back.
  • Loss of muscle mass. Some areas of the body, such as the arms and legs, will remain thin.
  • Pink or purple stretch marks (striae) on the skin of the abdomen, thighs, breasts and arms
  • Thinning, fragile skin that bruises easily
  • Slow healing of cuts, insect bites and infections
  • Acne

Women with Cushing’s syndrome may experience:

  • Thicker or more visible body and facial hair (hirsutism)
  • Irregular or absent menstrual periods

Men with Cushing’s syndrome may experience:

  • Decreased libido
  • Decreased fertility
  • Erectile dysfunction

Other signs and symptoms include:

  • Fatigue
  • Muscle weakness
  • Depression, anxiety and irritability
  • Loss of emotional control
  • Cognitive difficulties
  • New or worsened high blood pressure
  • Glucose intolerance that may lead to diabetes
  • Headache
  • Bone loss, leading to fractures over time
  • Hyperlipidemia (elevated lipids – cholesterol – in the blood stream)
  • Recurrent opportunistic or bacterial infections
Think you have Cushing’s?  Get to a doctor and don’t give up!

MaryO
         MaryO

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A Simple Mouse Click to Help Support Cushing’s Awareness Day!

Posted on April 3, 2012 by MaryO

Support Cushing’s …With A Click.

From Corcept, the makers of Korlym:

They say: “Corcept Therapeutics will donate $5 for every person who clicks to support people with Cushing’s. Corcept has jump-started the effort to build awareness and support with a $15,000 contribution to provide support through the Cushing’s Support and Research Foundation and Cushing’s Help. With your support, we can aim even higher!*

Take part…and spread the word.


*Donations up to $30,000. Program ends April 20, 2012″

Click here to make a difference!

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