Transformation of adrenal gland after adrenalectomy.

Adrenalectomy: Can This Procedure Reverse the Effects of Excess Cortisol?

Reese Marlowe in Health & Wellness August 2025 • 4 min read.

"Explore how adrenalectomy impacts body composition in patients with hypercortisolism, offering hope for those seeking relief from its debilitating effects."

Chronic exposure to elevated cortisol levels, a condition known as hypercortisolism, can wreak havoc on the body. Beyond the well-recognized Cushing's syndrome, milder forms of cortisol excess also pose significant health risks. Identifying effective ways to manage and reverse the effects of this hormonal imbalance is crucial for improving patient outcomes and quality of life.

One potential treatment option is adrenalectomy, the surgical removal of one or both adrenal glands. This procedure is often considered when hypercortisolism stems from adrenal tumors. But how effective is adrenalectomy in reversing the body composition changes induced by excess cortisol, such as increased visceral fat and decreased muscle mass? Understanding the specific improvements patients can expect is vital for informed decision-making.

Recent research investigates the impact of adrenalectomy on body composition using computed tomography (CT) scans to assess changes in visceral fat, muscle area, and muscle density. By comparing patients with varying degrees of cortisol excess, the study sheds light on the potential of adrenalectomy to restore a healthier body composition.

Understanding the Study: Adrenalectomy and Body Composition

Transformation of adrenal gland after adrenalectomy.

A retrospective observational study was conducted at Yonsei University College of Medicine, Severance Hospital, Seoul, Korea, between 2006 and 2017, involving 134 patients who underwent adrenalectomy for adrenal adenomas. The study participants were categorized into three groups based on their cortisol levels: overt Cushing's syndrome (CS), mild autonomous cortisol excess (MACE), and nonfunctioning adrenal tumor (NFAT). Follow-up CT scans were conducted on a subset of these patients (78 total) to assess changes in body composition after approximately one year.

The CT scans were analyzed to measure visceral fat area (VFA), subcutaneous fat area (SFA), skeletal muscle area (SMA), skeletal muscle index (SMI), and skeletal muscle radiodensity (SMD) at the third lumbar vertebra (L3). These measurements provided a detailed picture of how body composition changed in response to adrenalectomy and whether the extent of improvement varied depending on the initial level of cortisol excess.

Key measurements included:

Visceral Fat Area (VFA): Fat within the abdominal cavity around the organs.
Subcutaneous Fat Area (SFA): Fat beneath the skin.
Skeletal Muscle Area (SMA): Area of skeletal muscle at the L3 vertebra.
Skeletal Muscle Index (SMI): SMA adjusted for height.
Skeletal Muscle Radiodensity (SMD): A measure of muscle quality, inversely related to fat content within the muscle.

The study aimed to determine if the severity of cortisol excess was associated with a greater degree of improvement in CT-based body composition parameters after adrenalectomy. The data was analyzed to compare changes in VFA, SMA, and SMD among the three patient groups, adjusting for factors such as age, sex, body mass index (BMI), follow-up duration, and CT scanner type. This rigorous approach allowed researchers to isolate the impact of adrenalectomy on body composition while accounting for potential confounding variables.

Looking Ahead: The Promise of Adrenalectomy

This research offers valuable insights into the potential of adrenalectomy to reverse the adverse body composition changes associated with hypercortisolism. By demonstrating the link between cortisol excess and improvements in visceral fat, muscle mass, and muscle quality, the study underscores the importance of considering adrenalectomy as a treatment option for patients with adrenal adenomas and varying degrees of cortisol excess. Further prospective studies are needed to validate these findings and refine our understanding of the long-term benefits of adrenalectomy on body composition and overall health.

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Everything You Need To Know

What is hypercortisolism, and how does it impact the body?

Hypercortisolism refers to a condition characterized by chronic exposure to elevated cortisol levels. This hormonal imbalance can significantly affect the body, leading to various adverse effects. Elevated cortisol levels can cause detrimental changes to body composition, such as increased visceral fat and decreased muscle mass. It can also manifest as Cushing's syndrome, a severe form of hypercortisolism, but milder forms also pose health risks, underscoring the importance of understanding and addressing this condition. Besides body composition alterations, hypercortisolism can lead to various metabolic and cardiovascular issues, impacting overall health and well-being.

What is adrenalectomy, and in what context is it used as a treatment?

Adrenalectomy is the surgical removal of one or both adrenal glands. This procedure is often considered a treatment option when hypercortisolism stems from adrenal tumors, particularly adrenal adenomas. The rationale behind adrenalectomy is to eliminate the source of excess cortisol production, thereby addressing the underlying cause of the hormonal imbalance. By removing the affected adrenal gland(s), adrenalectomy aims to restore normal cortisol levels and reverse the adverse effects of hypercortisolism on the body.

How does adrenalectomy affect body composition, specifically concerning visceral fat and muscle mass?

Adrenalectomy has a notable impact on body composition, particularly concerning visceral fat and muscle mass. Research indicates that this procedure can lead to improvements in both areas. The surgical removal of the adrenal gland(s) aims to correct the hormonal imbalance, and as a result, patients often experience a reduction in Visceral Fat Area (VFA), meaning less fat within the abdominal cavity around the organs. Simultaneously, adrenalectomy can contribute to an increase in muscle mass and Skeletal Muscle Area (SMA), improving overall body composition. These changes are often assessed using computed tomography (CT) scans, which measure various parameters like VFA, SMA, and Skeletal Muscle Radiodensity (SMD) to quantify these improvements.

What specific body composition measurements were used to evaluate the impact of adrenalectomy in the study?

The study utilized several specific measurements derived from computed tomography (CT) scans to evaluate the impact of adrenalectomy on body composition. Key measurements included Visceral Fat Area (VFA), which quantifies fat within the abdominal cavity around the organs; Subcutaneous Fat Area (SFA), measuring fat beneath the skin; Skeletal Muscle Area (SMA), assessing the area of skeletal muscle at the L3 vertebra; Skeletal Muscle Index (SMI), which is SMA adjusted for height; and Skeletal Muscle Radiodensity (SMD), a measure of muscle quality, inversely related to fat content within the muscle. These measurements provided a comprehensive picture of how adrenalectomy influenced body composition parameters and allowed researchers to compare changes among different patient groups with varying degrees of cortisol excess.

What are the implications of the study's findings on adrenalectomy as a treatment option?

The study's findings offer valuable insights into the potential of adrenalectomy as a treatment for hypercortisolism. By demonstrating the link between cortisol excess and improvements in visceral fat, muscle mass, and muscle quality, the research underscores the importance of considering adrenalectomy as a treatment option, particularly for patients with adrenal adenomas and varying degrees of cortisol excess. The research supports the consideration of adrenalectomy to address the adverse effects of hypercortisolism on body composition. Further, prospective studies are needed to validate these findings and refine the understanding of the long-term benefits of adrenalectomy on body composition and overall health. This emphasizes the need for a nuanced approach to treatment, considering the severity of cortisol excess and individual patient characteristics.