Endocrine Abstracts

Endogenous hypercortisolism leads to increased morbidity and mortality. As Cushing’s disease (CD) is a rare disorder, data on co-morbidities outcome after current treatment interventions are scarce.

We studied 78 patients with CD (67 females, 11 males, mean age 42.2±1.4 years), with a follow up of 90.8±7.8 months. All patients underwent transsphenoidal surgery (TSS). The criterion for successful outcome was a post-operative morning cortisol <2 μg/dl followed by sustained normalization of cortisol secretion based on midnight, urinary and post-dexamethasone corisol levels. Patients who did not meet this criterion were submitted in a combination of second line treatments (medications, pituitary irradiation, and bilateral adrenalectomy) and were considered controlled if they achieved normal urinary cortisol and/or a mean serum cortisol level of <10 μg/dl.

Depending on treatment outcome patients were divided as follows: group A (n=18) patients successfully treated with TSS with normal pituitary function onwards, group B (n=11) patients successfully treated by TSS but with pituitary deficiencies, and group C (n=49) with persistence or recurrence of hypercortisolism under second line treatments. In the latter group 38 patients (group C1) were controlled while 11 patients were not (group C2).

The three groups did not differ in age, BMI, urinary and midnight cortisol levels at presentation.

A significant decline in the incidence of hypertension was noted in group A (from 44.4 to 11.1%, P=0.004) and in group B (from 81.8 to 18.2%, p=0.01). In group C a similar decline was noted only in group C1 (from 63.2 to 21.1%, P=0.03) but not in group C2. In all groups no statistical differences in the incidence of diabetes, osteoporosis/osteopenia and dyslipidemia were observed.

In conclusion, treatment of hypercortisolism leads to correction of hypertension, a well known mortality risk factor in CD. This improvement was observed in all controlled patients independently of the applied therapeutic interventions.