Abstract

Context

Muscle weakness is common in patients with Cushing’s syndrome (CS) and may persist after the resolution of hypercortisolism. Intramuscular fatty infiltration has been associated with the deterioration of muscle performance in several conditions.

Objectives

To quantify the degree of fatty infiltration in the thigh muscles of “cured” CS patients and evaluate the relationship between intramuscular fatty infiltration and physical performance.

Design

This was a cross-sectional study.

Setting

Tertiary referral center.

Patients

Thirty-six women with CS in remission, and 36 controls matched for age, BMI, menopausal status, and level of physical activity.

Main Outcome Measures

We analyzed the percentage fat fraction (FF) of the thigh muscles in the anterior, posterior, and combined anterior and posterior compartments using MRI and 2-point Dixon sequence. We assessed muscle function and strength using the following tests: gait speed (GS), timed up and go (TUG), 30-second chair stand, and hand grip strength.

Results

Fat fraction in all the compartments analyzed was increased in patients as compared with controls. The performance on TUG, 30-second chair stand, and GS was more impaired in CS patients versus controls. In patients, greater FF was negatively associated with performance on functional tests. Fat fraction in the combined anterior and posterior compartments predicted performance on TUG (ß 0.626, P < 0.000) and GS (ß -0.461, P = 0.007), after adjusting for age, BMI, menopausal status, and muscle mass.

Conclusions

Thigh muscle fatty infiltration is increased in “cured” CS patients and is associated with poorer muscle performance. Future studies are needed to establish therapeutic strategies to improve muscle weakness in these patients.