Ferhat Can PİŞKİN, Fulya ODABAŞ, Ulcaz Perihan AKSOYDAN, Gamze AKKUŞ

Otonom kortizol sekresyonu olan hastalarda ve fonksiyonel olmayan adrenal kitleleri olan hastalarda viseral yağ dokusunun karşılaştırılması

Amaç: Bu çalışmada sürekli otonom kortizol sekresyonunun (OKS) viseral adipoz doku, abdominal subkutan yağ dokusu ve total vücut yağı üzerindeki etkisinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Merkezimize sevk edilen adrenal kitlesi olan hastalar (n=57, kadın/erkek; 36/21) bu çalışmaya alındı. OKS'li otuz bir (n =31) hasta ve fonksiyonel olmayan adrenal insidentalomlu (FOAİ) 26 hasta dahil edildi. Hormonal değerlendirmeye yapıldı. Total, viseral ve subkutan yağ dokusu 3.0 T manyetik rezonans görüntüleme (Ingenia, Philips Medical Systems, Best, Hollanda) kullanılarak ölçüldü. Bulgular: Ortalama yaş, cinsiyet ve vücut kitle indeksi ölçümleri OKS'li hastalar ile FOAİ'li hastalar arasında benzerdi. Toplam (422,1±131,3'e karşı 346,2±86,0 cm3) ve viseral yağ dokusu (199,9±77,3'e karşı 160,6±60,8 cm3) hacimleri, OKS'li hastalarda FOAİ'li hastalara göre artmıştı. Diabetes mellitus varlığı ve hepatosteatoz, OKS'li hastalar ile FOAİ'li hastalar arasında benzerdi. Deri altı yağ dokusu hacimleri, viseral/deri altı ve viseral/toplam yağ oranı iki grupta benzerdi. Sonuç: OKS'li hastalarda total ve viseral yağ dokusu hacimleri cinsiyet, yaş ve BMI uyumlu FOAİ hastalarına göre daha yüksekti. Bu, OKS'li hastalarda sürekli hafif / hafif otonom kortizol sekresyonunun etkisini açıklayabilir.

Anahtar Kelimeler:

Otonom kortizol sekresyonu, fonksiyonel olmayan adrenal kitleleri, viseral yağ dokusu, manyetik rezonans görüntüleme

Comparison of visceral adipose tissue in patients with autonomous cortisol secretion and patients with the nonfunctional adrenal masses

Purpose: This study aimed to explore the impact of continuous autonomous cortisol secretion on visceral (VAT), abdominal subcutaneous (SAT) adipose tissue, and total body fat. Materials and Methods: A total of 57 patients (36 female, 21 male) with adrenal masses, referred to our single center, were included in this study. Among them, 31 patients had adrenal cortical carcinoma (ACS) and 26 had nonfunctional adrenal mass (NFAM). Hormonal evaluation was conducted for all patients. Measurements of total, visceral, and subcutaneous adipose tissue were performed using 3.0 T magnetic resonance imaging (Ingenia, Philips Medical Systems, Best, The Netherlands). Results: Mean age, gender distribution, and body mass index (BMI) were comparable between patients with ACS and NFAM. Patients with ACS exhibited higher volumes of both total (422.1±131.3 vs. 346.2±86.0 cm3) and visceral adipose tissue (199.9±77.3 vs. 160.6±60.8 cm3) compared to those with NFAM. Incidence rates of diabetes mellitus and hepatosteatosis were similar in both groups. Subcutaneous adipose tissue volumes, visceral-to-subcutaneous ratio, and visceral-to-total fat ratio showed no significant differences between the two groups. Conclusion: Patients with ACS demonstrated increased total and visceral fat tissue volumes compared to NFAM patients matched for gender, age, and BMI. This observation may elucidate the potential influence of continuous mild autonomous cortisol secretion in ACS patients. Such findings could serve as indicators of heightened cardiovascular risk among ACS patients.

Keywords:

Autonomus cortisol secretion, nonfunctional adrenal incidentalomas, visceral adipose tissue, magnetic resonance imaging,

PDF

___

Delivanis DA, Athimulam S, Bancos I. Modern management of mild autonomous cortisol secretion. Clin Pharmacol Ther. 2019;106:1209-21.
Bancos I, Alahdab F, Crowley RK, Chortis V, Delivanis DA, Erickson D et al. Therapy of Endocrine Disease: improvement of cardiovascular risk factors after adrenalectomy in patients with adrenal tumors and subclinical Cushing’s syndrome: a systematic review and meta-analysis. Eur J Endocrinol. 2016;175:283-95.
Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahdev A et al. Management of adrenal incidentalomas: European Society of endocrinology clinical practice guideline in collaboration with the European network for the study of adrenal tumors. Eur J Endocrinol. 2016;175:1-34.
Debono M, Bradburn M, Bull M, Harrison B, Ross R.J., Newell-Price J. Cortisol as a marker for increased mortality in patients with incidental adrenocortical adenomas. J Clin Endocrinol Metab. 2014;99:4462–70 .
Di Dalmazi G, Vicennati V, Garelli S, Casadio E, Rinaldi E, Giampalma E et al. Cardiovascular events and mortality in patients with adrenal incidentalomas that are either non-secreting or associated with intermediate phenotype or subclinical Cushing’s syndrome: a 15-year retrospective study. Lancet Diabetes Endocrinol. 2014;2:396–405.
Sbardella E, Minnetti M, D’Aluisio D, Rizza L, Di Giorgi MR, Vinci F et al. Cardiovascular features of possible automous cortisol secretion in patients with adrenal incidentaloma. Eur J Endocrinol. 2018;178:501-11.
Delivanis DA, Iñiguez-Ariza NM, Zeb MH, Monyagh MR, Takahashi N, Mckenzie T et al. Impact of hypercortisolism on skeletal muscle mass and adipose tissue mass in patients with adrenal adenomas. Clin Endocrinol (Oxf). 2018;88:209-16.
Constantinopulos P, Micholoi M, Kottorou A, Habeos I, Psyrogiannis A, Kalfarentzos F et al. Cortisol in tissues and systemic level as a contributing factor to the development of metabolic syndrome in severaly obese patients. Eur J Endocrinol. 2015;172:69-78.
Kumari M, Chandola T, Brunner E, Kivimaki M. A nonlinear relationship of generalized and central obesity with diurnal cortisol secretion in the Whitehall II study. J Clin Endocrinol Metab 2010;95:4415–23.
Sakurai T, Ogasawara J, Kizaki T, Sato S, Ishibashi Y, Takahashi M et al. The effects of exercise training on obesity-induced dysregulated expression of adipokines in white adipose tissue. Int J Endocrinol 2013;2013:1-28.
Schipper HS, Prakken B, Kalkhoven E, Boes M. Adipose-tissue resident immune cells: key players in immunometabolism. Trends Endocrinol Metab 2012;23:407-15.
Lee BC, Lee J. Cellular and molecular players in adipose tissue inflammation in the development of obesity-induced insulin resistance. Biochim Biophys Acta 2014;1842:446-62.
Sinelnikov A, Qu C, Fetzer DT, Pelletier J-S, Dunn MA, Tsung A et al. Measurement of skeletal muscle area: comparison of CT and MR imaging. Eur J Radiol. 2016;85:1716–21.
Kumari M, Chandola T, Brunner E, Kivimaki M. A nonlinear relationship of generalized and central obesity with diurnal cortisol secretion in the Whitehall II study. J Clin Endocrinol Metab 2010;95:4415–23.
Swainson M, Batterham A, Tsakirides C, Rutherford Z, Hind K. Prediction of whole-body fat percentage and visceral adipose tissue mass from five anthropometric variables. Plos One 2017;12:E0177175.
Morelli V, Palmieri S, Lania A, Tresoldi A, Corbetta S, Cairoli E et al.Cardiovascular events in patients with mild autonomous cortisol secretion: analysis with artificial neural networks. Eur J Endocrinol. 2017;177:73-83.
Bancos I, Alahdab F, Crowley RK, Chortis V, Delivanis D, Erickson D et al. Therapy of Endocrine Disease: improvement of cardiovascular risk factors after adrenalectomy in patients with adrenal tumors and subclinical Cushing’s syndrome: a systematic review and meta-analysis. Eur J Endocrinol. 2016;175:283-95.
Aresta C, Favero V, Morelli V, Givanelli L, Parazzoli C, Falchetti A et al. Cardiovascular complications of mild autonomous cortisol secretion. Best Pract Res: Clin Endocrinol. 2021;35:2.
19)Goedecke JH, Chorell E, Livingstone DE, Stimson RH. Glucocorticoid receptor gene expression in adipose tissue and associated metabolic risk in black and white South African women. Int J Obes. 2015;39:303-15.
Ragnarsson O, Glad CA, Bergthorsdottir R, Almqvist EG, Ekerstad E, Widell H et al. Body composition and bone mineral density in women with Cushing's syndrome in remission and the association with common genetic variants influencing glucocorticoid sensitivity. Eur J Endocrinol. 2015;172:1-10.
Bujalska IJ, Kumar S, Stewart PM. Does central obesity reflect “Cushing's disease of the omentum”? Lancet. 1997;349:1210-13.
Jung Han Na, Cheng He Jung. The role of anti-inflammatory adipokines in cardiometabolic disorders: moving beyond adiponectin. Int J Mol Sci. 2021;22:13529.
Taheri E., Hosseini S., Qorbani M., Mirmiran P. Association of adipocytokines with lipid and glycemic profiles in women with normal weight obesity. BMC Endocr. Disord. 2020;20:171.
Lee SH. Adipokine profiles and metabolic health. Endocrinol Metab (Seoul). 2015;30:175–6.
Elfeky M, Yoneshiro T, Okamatsu-Ogura Y, Kimura K. Adiponectin suppression of late inflammatory mediator, HMGB1-induced cytokine expression in RAW264 macrophage cells. J Biochem. 2018;163:143–53.
Darabi H, Raeisi A, Kalantarhormozi MR, Ostovar A, Assadi M, Asadipooya K et al. Adiponectin as a protective factor against the progression toward type 2 diabetes mellitus in postmenopausal women. Medicine (Baltimore) 2015;94:e1347.
Yener S, Baris M, Peker A, Demir O, Ozgen B, Secil M. Autonomous cortisol secretion in adrenal incidentalomas and increased visceral fat accumulation during follow-up. Clin Endocrinol (Oxf). 2017;87:425-32.
Debono M, Prema A, Hughes TJ, Bull M, Ross RJ, Newell-Price J.Visceral fat accumulation and postdexamethasone serum cortisol levels in patients with adrenal incidentaloma. J Clin Endocrinol Metab. 2013;98:2383-91.