ORIGINAL ARTICLE

A Slight Contribution of Retroperitoneal Fat Accumulation to the Metabolic Comorbidities of Patients with Autonomous Cortisol Production
Retroperitoneal Yağ Birikiminin Otonom Kortizol Üretimi Olan Hastaların Metabolik Komorbiditelerine Hafif Derecede Katkısı
Received Date : 15 May 2020
Accepted Date : 16 Nov 2020
Available Online : 10 Dec 2020
Doi: 10.25179/tjem.2020-76323 - Makale Dili: EN
Turk J Endocrinol Metab. 2020;24:277-283
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
Objective: Autonomous cortisol secretion (ACS) in the adrenal incidentaloma (AI) refers to an excess of low-grade autonomous cortisol without the clinical symptoms of Cushing’s syndrome (CS), while ACS is shown to be related to the accumulation of visceral fat. To elucidate whether the accumulation of fat in different compartments, such as total adipose tissue (TAT), peritoneal adipose tissue (PAT), retroperitoneal adipose tissue (RPAT), and subcutaneous adipose tissue (SAT) could predict metabolic problems in patients with ACS. Material and Methods: We conducted a retrospective cohort study, including 74 patients diagnosed with ACS and 8 patients diagnosed with CS. 8 patients with ACS had also undergone adrenalectomy. Baseline (initial admission) and follow- up (most recent visit) data, including the clinical, laboratory, and radiological parameters, were evaluated. Results: Total adipose tissue (TAT), visceral adipose tissue (VAT), PAT, and RPAT increased significantly while the SAT remained stable in patients with ACS. Adrenalectomy in patients with CS resulted in a significant reduction of TAT, VAT, PAT, and RPAT while SAT was relatively preserved. However, no significant change was observed in surgically treated patients with ACS. The independent predictors of cardiovascular events, glucose intolerance, or elevated blood pressure were age, the level of cortisol post dexamethasone suppression test (DexF), and an increase in the RPAT. Conclusion: Visceral fat accumulation, particularly in the retroperitoneal area, slightly contributed to the development of metabolic problems in patients with ACS.
ÖZET
Amaç: Adrenal insidentalomalarda görülen otonom kortizol sekresyonu (OKS), visseral yağ akümülasyonuna neden olmakla birlikte, Cushing Sendromu (CS) klinik bulguları oluşturmadan, düşük dereceli otonom kortizol yüksekliğine yol açmaktadır. Çalışmamızda, total (TAT), peritoneal (PAT), retroperitoneal (RPAT) ve subkutanöz (SAT) gibi değişik kompartımanlardaki yağ akümülasyonunun OKS olan hastalardaki metabolik problemleri öngörme gücünün değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmamız, OKS tanılı 74 hasta ve CS tanılı 8 hastanın dâhil edildiği retrospektif kohort çalışmasıdır. OKS tanısı olan 8 hastaya adrenalektomi cerrahisi uygulanmıştır. İlk değerlendirme ve takip değerlendirmesine (en son gerçekleştirilen değerlendirme) ait klinik, laboratuvar ve radyolojik parametreler değerlendirilmiştir. Bulgular: OKS olan hastalarda total adipoz doku (TAT), visseral adipoz doku (VAT), PAT ve RPAT anlamlı şekilde artış gösterirken, SAT stabil kalmaktadır. CS hastalarda uygulanan adrenalektomi, anlamlı düzeyde TAT, VAT, PAT ve RPAT azalışına sebep olmakta iken, SAT rölatif olarak korunmuştur. Bununla birlitke, cerrahi olarak tedavi edilen OKS hastalarında anlamlı değişiklik izlenmemiştir. Yaş, deksametazon supresyon testi sonrası kortizol düzeyleri (DexF) ve RPAT daki artış, kardiyovaskuler olay, glukoz intoleransı ve yüksek tansiyon için bağımsız prediktörler olarak saptanmıştır. Sonuç: Özellikle retroperitoneal alandaki viseral yağ akümülasyonu, OKS’li hastalarda metabolik problemlerin gelişmesine az da olsa katkıda bulunmaktadır.
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