Adipose tissue in cortisol excess: What Cushing’s syndrome can teach us?

• Published in: Biochemical pharmacology 2024-05, Vol.223, p.116137, Article 116137
• Main Authors: Bavaresco, Alessandro, Mazzeo, Pierluigi, Lazzara, Martina, Barbot, Mattia
• Format: Article
• Language: English
• Subjects: 11β-Hydroxysteroid dehydrogenase; Adipose tissue; Cortisol excess; Cushing’s syndrome; Dyslipidaemia; Visceral adiposity
• ISSN: 0006-2952; 1873-2968; 1873-2968
• DOI: 10.1016/j.bcp.2024.116137

[Display omitted] Endogenous Cushing’s syndrome (CS) is a rare condition due to prolonged exposure to elevated circulating cortisol levels that features its typical phenotype characterised by moon face, proximal myopathy, easy bruising, hirsutism in females and a centripetal distribution of body fat. Given the direct and indirect effects of hypercortisolism, CS is a severe disease burdened by increased cardio-metabolic morbidity and mortality in which visceral adiposity plays a leading role. Although not commonly found in clinical setting, endogenous CS is definitely underestimated leading to delayed diagnosis with consequent increased rate of complications and reduced likelihood of their reversal after disease control. Most of all, CS is a unique model for systemic impairment induced by exogenous glucocorticoid therapy that is commonly prescribed for a number of chronic conditions in a relevant proportion of the worldwide population. In this review we aim to summarise on one side, the mechanisms behind visceral adiposity and lipid metabolism impairment in CS during active disease and after remission and on the other explore the potential role of cortisol in promoting adipose tissue accumulation.