A quantitative tool to assess degree of sarcopenia objectively in patients with hypercortisolism

BackgroundMuscle weakness and wasting are known manifestations of hypercortisolism (HC). Central sarcopenia is a marker of frailty and predicts mortality. The hypothesis of this study is that central sarcopenia can be used as a marker of disease severity and frailty in patients with HC.MethodsPsoas muscle area and psoas muscle density (PMD) were measured at specific points on CT scans of patients with HC using a defined protocol. We compared 24-hour urine cortisol (24HUC) levels by time point to each CT scan. A linear regression model was used to describe the relationship between 24HUC and morphometric variables. A comparison with matched non-HC patients was performed.ResultsWe identified 45 patients (34 female). The median age was 46 years (range, 14–80); the median 24HUC was 211 mg/dL (range, 9.5–39,500); the median PMD was 50.1 24HUC (range, 20–72). An inverse correlation (−0.29) between 24HUC levels and PMD was noted (P = .045). Intra-abdominal fat was also significantly and positively correlated with 24HUC: 27 non-HC patients matched for age, sex, and body-mass index showed higher (58 vs 51) PMD (P = .0127) compared to those with HC.ConclusionPMD and intra-abdominal fat are significantly related to 24HUC levels. Morphometric measures of the overall burden of HC may allow more precise assessment of disease severity.