CT scan visualization of body composition changes after adrenalectomy, emphasizing muscle and fat distribution.

Adrenalectomy's Ripple Effect: Body Composition Changes Unveiled

Kai Mendoza in Health & Wellness December 2025 • 4 min read.

"A deep dive into how removing adrenal glands can reshape body fat and muscle, offering new paths in treating hypercortisolism."

When the adrenal glands go into overdrive, the result can be a condition known as hypercortisolism – an excess of cortisol that throws the body's systems out of balance. Often marked by weight gain, muscle weakness, and a host of other health issues, managing hypercortisolism is a complex challenge that often leads medical professionals to consider adrenalectomy.

Adrenalectomy, the surgical removal of one or both adrenal glands, aims to address the root of the problem by eliminating the source of excess cortisol. But what happens after the surgery? How does the body's composition—muscle and fat—shift and change? Recent research sheds light on these fascinating transformations, offering insights into how we understand and treat hypercortisolism.

A groundbreaking study has leveraged computed tomography (CT) scans to map the before-and-after landscape of body composition in patients undergoing adrenalectomy. This approach goes beyond simple weight measurements, diving deep into the distribution of visceral fat, muscle mass, and muscle quality, providing a detailed picture of the body's response to this significant surgical intervention.

Decoding CT Scans: What Changes in Muscle and Fat Really Mean?

CT scan visualization of body composition changes after adrenalectomy, emphasizing muscle and fat distribution.

The study meticulously tracked changes in visceral fat area (VFA), skeletal muscle area (SMA), and skeletal muscle radiodensity (SMD) using CT scans. These measurements offer a comprehensive view, moving beyond just size and delving into the quality of muscle tissue. Analyzing these factors can reveal a lot about a person's overall health and how their body is responding to treatment.

The research divided patients into three groups: those with overt Cushing's syndrome (CS), mild autonomous cortisol excess (MACE), and nonfunctioning adrenal tumors (NFAT). By comparing the CT scans of these patients pre- and post-adrenalectomy, researchers uncovered distinct patterns of change unique to each group.

Visceral Fat (VFA): This is the fat that lurks deep within the abdomen, surrounding vital organs. High levels of visceral fat are linked to increased health risks.
Skeletal Muscle Area (SMA): Reflects the quantity of muscle tissue. Maintaining adequate muscle mass is crucial for strength, mobility, and metabolic health.
Skeletal Muscle Radiodensity (SMD): A measure of muscle quality. Higher SMD indicates less fat within the muscle tissue, reflecting better muscle health and function.

The findings revealed that patients with overt Cushing's syndrome experienced the most dramatic improvements after adrenalectomy. These patients saw significant reductions in visceral fat and increases in both muscle mass and muscle quality. Those with MACE also saw positive changes, particularly in muscle quality, while the NFAT group remained relatively stable.

A New Horizon for Personalized Treatment Strategies

This research underscores the potential of CT-based body composition analysis as a valuable tool in managing hypercortisolism. By providing a detailed view of how individual patients respond to adrenalectomy, these scans can help doctors tailor treatment plans, predict outcomes, and optimize care for those undergoing this transformative surgery. As research continues, these insights pave the way for more precise and effective interventions, empowering patients on their journey to restored health and well-being.

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Everything You Need To Know

What is hypercortisolism, and why is it a concern?

Hypercortisolism is a condition where the body produces too much cortisol. This imbalance can lead to weight gain, muscle weakness, and various other health problems. Managing hypercortisolism is often complex, sometimes requiring medical professionals to consider an adrenalectomy to manage this condition. The implications of untreated hypercortisolism can be significant, impacting overall health and well-being, which is why addressing the root cause is so important.

What exactly is an adrenalectomy, and why is it performed?

An adrenalectomy is a surgical procedure involving the removal of one or both adrenal glands. This procedure is often considered when the adrenal glands are producing excess cortisol, leading to conditions like Cushing's syndrome or mild autonomous cortisol excess. The aim is to eliminate the source of excess hormone production. Understanding the changes in body composition, such as muscle and fat distribution, post-adrenalectomy is crucial for optimizing patient care.

How are CT scans used to evaluate changes after an adrenalectomy?

CT scans play a crucial role in assessing body composition changes post-adrenalectomy. They allow medical professionals to go beyond simple weight measurements by providing detailed insights into the distribution of visceral fat area (VFA), skeletal muscle area (SMA), and skeletal muscle radiodensity (SMD). Analyzing these factors helps doctors understand how a patient's body is responding to the surgery and tailor treatment plans accordingly. For example, they can reveal whether a patient is losing visceral fat or gaining muscle mass.

What do visceral fat area, skeletal muscle area, and skeletal muscle radiodensity tell us?

Visceral fat area (VFA) refers to the amount of fat located deep within the abdomen, surrounding vital organs. High levels of visceral fat are associated with increased health risks. Skeletal muscle area (SMA) reflects the quantity of muscle tissue, which is crucial for strength, mobility, and metabolic health. Skeletal muscle radiodensity (SMD) measures muscle quality, with higher SMD indicating less fat within the muscle tissue, reflecting better muscle health and function. Monitoring these specific measurements helps in assessing the impact of adrenalectomy on body composition.

What kind of changes can be expected in patients after adrenalectomy, and does it vary?

After an adrenalectomy, patients with overt Cushing's syndrome tend to experience the most significant improvements, including reductions in visceral fat and increases in both muscle mass and muscle quality. Patients with mild autonomous cortisol excess also show positive changes, particularly in muscle quality. Meanwhile, those with nonfunctioning adrenal tumors may experience relatively stable body composition. These varying responses highlight the importance of personalized treatment strategies based on individual conditions and CT scan results.