Weight gain in Cushings; explain??

[verok1943]

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Goljan says that in Cushings, you get a weight gain due to hyperinsulinism in response to hyperglycemia that occurs with excess cortisol

But this doesn't seem to make sense to me physiologically. When I cross reference with Costanzo, she says the actions of cortisol include, decreased glucose utilization, decreased insulin sensitivity of adipose tissue, and increased lipolysis. But yet patients with Cushings present with weight gain

Can anyone clear up my confusion?

 

[dorster]

Well the only thing I can really add is from a completely non biochem standpoint. Cortisol increases hunger. Also they gain a lot of water weight from the the salt retention. Plus I think its more of a "redistribution of fat" which is caused by the lipolysis rather than just a total increase in fat. You're right there is lipolysis so its not that they are adding more fat cells its that the fat is being distributed in places it shouldn't.

But also I think there is hyperinsulinism at first.. then that increased insulin over times makes the tissue less responsive to the insulin which leads to insulin resistance.