Glucocorticoids are steroid hormones that bind to the glucocorticoid receptor (GR), a member of the steroid hormone receptor superfamily of transcription factors. Excessive glucocorticoid secretion induces obesity, metabolic disturbances, and liver steatosis in patients with Cushing's syndrome. We investigated the metabolic role of adipocyte GR in Cushing's syndrome using adipocyte-specific GR knockout (AGRKO) mice and clinical samples from patients with Cushing's syndrome. AGRKO mice showed healthy adipose tissue expansion with diminished ectopic lipid deposition and improved insulin sensitivity after chronic corticosterone treatment. These changes were associated with adipose triglyceride lipase (Atgl)-mediated lipolysis. Additionally, integrated analysis with RNA sequencing of white adipose tissue from AGRKO mice and patients with Cushing's syndrome revealed that the healthy adipose tissue expansion was associated with the dysregulation of tissue remodeling and preadipocyte proliferation. Therefore, our study revealed the role of adipocyte GR in healthy adipose tissue expansion and its multiple mechanisms of action in Cushing's syndrome.

A 6-year-old boy with a history of urticaria reacting to cashew nuts accidentally ingested three cashews during school lunch. He experienced nausea but was able to clean the classroom. He developed a rash and itching after classroom cleaning. He took olopatadine hydrochloride but showed no improvement. On discovering that he had accidentally ingested cashew nuts, an ambulance was called to transfer him to our hospital. He showed tachycardia at 132 bpm with a blood pressure of 88/38 mmHg, and anaphylaxis was highly suspected. He was diagnosed with anaphylactic shock due to generalized erythema, tachycardia, mild hypotension, and drowsiness; he was promptly given an intramuscular adrenaline injection. He required three further intramuscular adrenaline injections: two were due to prolonged hypotension, and one was due to respiratory distress and hypoxemia. This case was unusual because the patient necessitated four intramuscular injections of adrenaline. Four factors contributed to the incident: the food being cashews, the boy performing physical activity after the ingestion, the delay in initial treatment, and the failure to administer intramuscular adrenaline injection at the appropriate time. Early intramuscular injection of adrenaline is important to prevent severe anaphylaxis.