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

Adrenalectomy's Ripple Effect: Body Composition Changes Unveiled

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Kai Mendoza in Health & Wellness October 2026 • 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.

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Changes After Treatment

In women treated for Cushing’s syndrome, adipose tissue decreased by 8.2 ± 6.1 kg (P = .012); changes in skeletal muscle plus skin (−1.3 ± 1.7 kg) and visceral organs (−0.6 ± 1.0 kg) were not statistically significant. At long-term follow-up, adrenalectomy significantly improved hypertension and diabetes in affected patients, and hypercortisolism was resolved in all cases. These findings describe different outcomes—body-composition change and clinical comorbidities—rather than a single measure of recovery.

Imaging Methods and Evidence Gaps

One described CT approach estimates muscle and whole-body composition by measuring cross-sectional area on a single axial slice, using thresholds of −29 to +150 Hounsfield units to segment muscle and −190 to −30 HU to assess intermuscular fat. Evidence on treatment strategies for mild autonomous cortisol secretion (MACS) remains limited and methodologically heterogeneous, and the source calls for a randomized controlled trial to assess adrenalectomy’s impact on morbidity. It also reports reduced use of antihypertensive drugs after adrenalectomy in patients with Cushing’s syndrome, autonomous cortisol secretion, and non-functioning adrenocortical adenoma.

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.
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Recent Cohort Studies

A study at a tertiary endocrine surgery center evaluated 114 consecutive patients who underwent minimally invasive adrenalectomy for overt Cushing’s syndrome or mild autonomous cortisol secretion over a 20-year period. A separate observational, retrospective, single-center study included 62 patients with confirmed endogenous ACTH-independent hypercortisolism followed between January 2019 and January 2024. The provided summaries give study designs and cohort details but do not report body-composition outcomes for either study.

Limits of the Observational Evidence

A retrospective observational cohort study included 134 patients treated at a tertiary endocrinology institution between 2006 and 2017. The cohort comprised 39 patients with overt Cushing’s syndrome, 57 with mild autonomous cortisol excess, and 38 with nonfunctioning adrenal tumours. Because the study was retrospective and observational, its design limits how confidently any changes can be attributed to adrenalectomy itself.

Different Conditions, Different Fat Changes

A CT-based study of patients with pheochromocytoma reported increases after adrenalectomy of 15.8% in subcutaneous fat area (SFA) and 14.5% in visceral fat area (VFA); catecholamine metabolite levels were primarily related to SFA rather than VFA. By contrast, in a prospective DXA study of Cushing’s syndrome, fat-mass reduction was greater among patients who achieved surgical remission: 17.26% for total body, 22.73% for trunk, and 21.21% for the R1 box, all with P < .05. These findings concern different conditions and measurement approaches, so they should not be treated as directly comparable estimates of one shared effect.

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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A Two-Sided Hormonal Effect

The cited review describes glucocorticoids (GCs) as having a dual role in adipose tissue, promoting both lipolysis and lipogenesis. It links these actions to dyslipidemia, adipose-tissue changes, and visceral obesity in mild autonomous cortisol secretion (MACS). This account points to a complex relationship between cortisol and fat distribution, rather than a single uniform direction of change.

Muscle mass compared with nonfunctioning tumors

  • -10 cm2Patients with overt Cushing’s syndrome had 10 cm2 less total muscle mass than patients with nonfunctioning adrenal tumors.[1]

What the muscle comparison adds

This comparison places lower muscle mass alongside overt Cushing’s syndrome, rather than showing that surgery changes muscle mass. It does not establish why the groups differed.[1]

How the measurements and evidence fit together

A single CT slice at the third lumbar vertebra can assess subcutaneous fat, visceral fat, and skeletal muscle tissue volumes. This describes what the imaging captures, not whether those measures represent strength or whole-body function.[2]

Abdominal visceral adiposity and central sarcopenia are described as markers associated with cardiovascular risk and mortality; those associations give the body-composition measures clinical context, but are not outcomes demonstrated by the muscle comparison.[1]

The CT-based cohort was retrospective and observational. Its design describes patterns among treated patients, but by itself does not establish that adrenalectomy caused those patterns.[3]

What remains unresolved about body composition

  • Do changes in CT-measured tissue and changes in grip strength track together after treatment? The available excerpts report these measures separately and do not establish their relationship.[3] [4]
  • How do glucocorticoids’ effects that promote both fat breakdown and fat formation contribute to visceral obesity in mild autonomous cortisol excess? The described dual role leaves the direction of change dependent on more than a single process.[5]

Sources

  1. Impact of hypercortisolism on skeletal muscle mass and adipose tissue mass in patients with adrenal adenomas. (pubmed.ncbi.nlm.nih.gov)
  2. Change of Computed Tomography-Based Body Composition after Adrenalectomy in Patients with Pheochromocytoma (pmc.ncbi.nlm.nih.gov)
  3. Changes of computed tomography-based body composition after adrenalectomy in patients with endogenous hypercortisolism. (onlinelibrary.wiley.com)
  4. Persisting Muscle Dysfunction in Cushing’s Syndrome Despite Biochemical Remission (pmc.ncbi.nlm.nih.gov)
  5. Comparison of adrenalectomy with conservative treatment on mild autonomous cortisol secretion: a systematic review and meta-analysis (pmc.ncbi.nlm.nih.gov)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

Everything You Need To Know

1

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.

2

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.

3

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.

4

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.

5

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.

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