Unlocking the secrets of metabolic syndrome: retroperitoneal fat area as a novel predictor.

Objective: Metabolic syndrome (MetS) affects about one-fourth of the global adult population and is characterized by hyperglycemia, abdominal obesity, low HDL (high-density lipoprotein cholesterol) cholesterol, and high triglycerides and blood pressure. Its emergence in developed nations is linked to energy intake imbalances and sedentary lifestyles. There is a parallel between MetS and conditions marked by glucocorticoid excess, such as Cushing's syndrome (CS), sharing features like central obesity, hypertension, dyslipidemia, and insulin resistance. This study aimed to investigate the association between retroperitoneal fat area (RFA) and MetS components in patients undergoing laparoscopic lateral transabdominal adrenalectomy. While intra-abdominal visceral fat's role in MetS has been studied, the significance of RFA needs further exploration.

Patients and methods: The research involved 88 patients categorized into three groups: adrenal-dependent CS, subclinical CS (SCS), and nonfunctional adrenal incidentaloma (NFA). Parameters, including body mass index (BMI), RFA, waist circumference, blood pressure, lipid profile, and fasting glucose levels, were measured. The study used hormonal hypersecretion assessments, criteria for SCS diagnosis, and biochemical analyses. MetS components were determined based on established criteria, and RFA quantification used advanced imaging software on computed tomography (CT) scans. Previous studies on intra-abdominal fat and MetS were reviewed to contextualize the findings.

Results: Patients with MetS had significantly higher BMI, waist circumference, and RFA compared to those without MetS. Positive correlations were observed between BMI, RFA, central obesity, and MetS. ROC curve analysis showed a significant relationship between RFA and MetS, with a cutoff value of 36.6 cm² predicting MetS accurately in 95% of cases. The results were compared with existing literature on visceral fat's impact on MetS.

Conclusions: The study findings underscore the associations between anthropometric parameters, specifically RFA and MetS. RFA is a valuable tool for assessing metabolic risk, with implications for refining criteria for adrenalectomy in individuals with adrenal incidentalomas.