Persisting Muscle Dysfunction in Cushing's Syndrome Despite Biochemical Remission.

Abstract

CONTEXT:

Glucocorticoid-induced myopathy is a characteristic symptom of endogenous Cushing's syndrome (CS). Its long-term outcome is largely unknown.

OBJECTIVE:

To evaluate long-term muscle function following the remission of endogenous CS.

STUDY DESIGN:

Observational longitudinal cohort study.

SETTING:

Tertiary care hospitals and a specialized outpatient clinic.

PATIENTS:

As part of the prospective multicenter German Cushing's Registry, we assessed muscle strength in patients with overt endogenous CS. We studied the patients at the time of diagnosis (n = 88), after 6 months (n = 69), and thereafter annually, following surgical remission over a period of up to 4 years (1 year: n = 55; 2 years: n = 34; 3 years: n = 29; 4 years: n = 22). Muscle function was evaluated by hand grip strength and by chair rising test.

RESULTS:

Grip strength was decreased to 83% of normal controls (100%) at the time of diagnosis. It further decreased to 71% after 6 months in remission (P ≤ 0.001) and showed no improvement during further follow-up compared with baseline. Chair rising test performance improved initially (8 seconds at baseline vs 7 seconds after 6 months, P = 0.004) but remained at this reduced level thereafter (7 seconds after 3 years vs 5 seconds in controls, P = 0.038). In multivariate analysis, we identified, as predictors for long-term muscle dysfunction, age, waist-to-hip ratio, and hemoglobin A1c at baseline. Furthermore, muscle strength during follow-up was strongly correlated with quality of life.

CONCLUSION:

This study shows that CS-associated myopathy does not spontaneously resolve during remission. This calls for action to identify effective interventions to improve muscle dysfunction in this setting.

• Authors: Frederick Vogel, Leah T Braun, German Rubinstein, Stephanie Zopp, Heike Künzel, Finn Strasding, Adriana Albani, Anna Riester, Ralf Schmidmaier, Martin Bidlingmaier, Marcus Quinkler, Timo Deutschbein, Felix Beuschlein, Martin Reincke
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 105 Issue 12 (12 01 2020) ISSN: 1945-7197 [Electronic] United States
• PMID: 32882010 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © Endocrine Society 2020.

Chemical References

• Biomarkers

Topics

• Adult
• Biomarkers (analysis)
• Case-Control Studies
• Cohort Studies
• Cushing Syndrome (complications, diagnosis, physiopathology, surgery)
• Female
• Germany
• Hand Strength (physiology)
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Muscle Strength (physiology)
• Muscular Diseases (diagnosis, etiology, physiopathology, surgery)
• Prognosis
• Quality of Life
• Remission Induction
• Time Factors
• Treatment Outcome