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
The Journal of Clinical Endocrinology & Metabolism, Volume 105, Issue 12, December 2020, Pages e4490–e4498
https://doi.org/10.1210/clinem/dgaa625
Glucocorticoid-induced myopathy is a characteristic symptom of endogenous Cushing’s syndrome (CS). Its long-term outcome is largely unknown.
To evaluate long-term muscle function following the remission of endogenous CS.
Observational longitudinal cohort study.
Tertiary care hospitals and a specialized outpatient clinic.
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.
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.
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.
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