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

Surgery. 2011 Dec;150(6):1178-85. doi: 10.1016/j.surg.2011.09.020.


Background: Muscle 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.

Methods: Psoas 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.

Results: We 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.

Conclusion: PMD 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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / urine
  • Case-Control Studies
  • Cushing Syndrome / complications*
  • Cushing Syndrome / urine
  • Female
  • Humans
  • Hydrocortisone / urine*
  • Intra-Abdominal Fat / diagnostic imaging
  • Linear Models
  • Male
  • Middle Aged
  • Psoas Muscles / diagnostic imaging*
  • Psoas Muscles / pathology
  • Retrospective Studies
  • Sarcopenia / classification*
  • Sarcopenia / diagnosis
  • Sarcopenia / etiology
  • Severity of Illness Index
  • Subcutaneous Fat, Abdominal / diagnostic imaging
  • Tomography, X-Ray Computed
  • Young Adult


  • Biomarkers
  • Hydrocortisone