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A prospective study of appetite and food craving in 30 patients with Cushing’s disease

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Abstract

Context

Glucocorticoid (GC) exposure increases food intake, but the mechanisms in humans are not known. Investigation of appetite and food craving has not been done in patients with chronic GC exposure due to Cushing’s disease (CD), either before or after treatment, and could provide insight into mechanisms of food intake and obesity in these patients.

Purpose

To examine whether surgical remission of CD changes appetite (prospective consumption, hunger, satisfaction, and fullness) and food cravings (sweet, salty, fatty, and savory); and to identify predictors of appetite and craving in CD remission.

Methods

30 CD patients, mean age 40.0 years (range 17–70), mean BMI 32.3 ± 6.4, were prospectively studied before and at a mean of 17.4 mo. after remission. At each visit fasting and post-test meal (50 % carbohydrate, 35 % protein, 15 % fat) appetite and craving scores were assessed.

Results

Remission decreased prospective consumption, sweet and savory craving (p < 0.05), but did not change hunger, satisfaction, fullness, or fat craving, despite decreases in BMI and fat mass. In CD remission, serum cortisol predicted lower satisfaction and fullness, and masses of abdominal fat depots predicted higher hunger and consumption (p < 0.05).

Conclusions

Chronic GC exposure in CD patients may stimulate the drive to eat by enhancing craving, rather than regulating the sensation of hunger. Continued alterations in appetite regulation due to abdominal fat mass and circulating cortisol could play a role in the cardiovascular and metabolic risk that has been reported in CD patients despite remission.

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Acknowledgments

The authors wish to thank the individuals who volunteered to participate in this study, the staff at the Mount Sinai Clinical Research Unit, Mark Punyanitya at the Image Reading Center, and Marie Grace at the Mount Sinai Clinical laboratory. Supported by National Institutes of Health Grant K23 DK 082617 and Mount Sinai General Clinical Research Center CReFF award MO1-RR-00071 to EBG, Grant UL1TR000067 to the Mount Sinai CTSA, Grant TL1RR029886 from the National Center for Research Resources, and Grant K24 DK 073040 to PUF.

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Authors and Affiliations

  1. Department of Medicine, Division of Endocrinology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1055, New York, NY, 10029, USA

    Eliza B. Geer

  2. Department of Neurosurgery, Mount Sinai Medical Center, New York, NY, 10029, USA

    Eliza B. Geer, Yelena Lalazar, Vanessa Cohen, Joshua Bederson, Jane Kostadinov & Kalmon D. Post

  3. Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    Wei Shi & Emilia Bagiella

  4. Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    Lizette M. Couto & Lianna R. Lipton

  5. Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA

    Irene Conwell & Pamela U. Freda

Authors
  1. Eliza B. Geer
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  2. Yelena Lalazar
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  3. Lizette M. Couto
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  4. Vanessa Cohen
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  5. Lianna R. Lipton
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  6. Wei Shi
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  7. Emilia Bagiella
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  8. Irene Conwell
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  9. Joshua Bederson
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  10. Jane Kostadinov
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  11. Kalmon D. Post
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  12. Pamela U. Freda
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Corresponding author

Correspondence to Eliza B. Geer.

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Supplemental Figure 1

Mean fasting and post-meal total ghrelin and PYY concentrations in 18 CD patients before and after surgical remission. Surgical remission increases mean fasting and post-meal total ghrelin (A) but not PYY (B) concentrations. Supplementary material 1 (XLSX 22 kb)

Supplementary material 2 (XLSX 14 kb)

Supplementary material 3 (XLSX 15 kb)

Supplementary material 4 (XLSX 16 kb)

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Geer, E.B., Lalazar, Y., Couto, L.M. et al. A prospective study of appetite and food craving in 30 patients with Cushing’s disease. Pituitary 19, 117–126 (2016). https://doi.org/10.1007/s11102-015-0690-1

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  • DOI: https://doi.org/10.1007/s11102-015-0690-1

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