Endocrine Abstracts

Background: Cortisol excess in Cushing’s disease (CD) leads to metabolic complications, thromboembolic events, and increased cardiovascular risk. The aim of this study was to assess the reversibility of glucose homeostasis alterations and dynamics of inflammatory and coagulation parameters following the successful transsphenoidal surgery.

Methods: The group consisted of 14 patients with CD (11 females; age: 41.5±14.5) operated on according to the same protocol. Anthropometric parameters, glucose and insulin levels during an oral glucose tolerance test (OGTT), HbA1c, hsCRP, fibrinogen, and D-dimers were assessed prior to, and 3 months after surgery. HOMA–IR, QUICKI, and Matsuda indices were calculated. Patients previously diagnosed with diabetes were assessed exclusively for fasting glucose and HbA1c.

Results: Three patients (21.4%) had been diagnosed with diabetes prior to CD confirmation. Three patients (21.4%) were diagnosed with diabetes based on OGTT results prior to surgery. Six patients (42.8%) were diagnosed with impaired glucose tolerance. Three months after the surgery, significant reduction in waist (119.7±15.5 vs 114.7±14.7 cm, P<0.001) and hip (113.8±14.8 vs 109.1±12.4 cm, P<0.05) circumference was observed. A significant decrease in OGTT parameters was confirmed: mean blood glucose (159.3±35.9 vs 123.4±22.8 mg/dl, P<0.05), 120-min blood glucose (170±58 vs 128.6±39.8 mg/dl, P<0.05), and 90-min insulin (205.5±115.8 vs 122.6±100.2 μIU/ml, P<0.05). The Matsuda index improved significantly (1.76±1.0 vs 3.4±2.2, P<0.05). No differences were observed in BMI, mean and fasting insulin levels, HbA1c, HOMA-IR and QUICKI, hsCRP, D-dimers and fibrinogen.

Conclusion: Three months following successful surgical treatment of CD significant improvements in waist and hip circumference as well as a decrease in mean OGTT glucose levels could already be seen. The Matsuda index, which is based on mean OGTT glucose and insulin levels, might be the most sensitive out of IR indices in the early postoperative period. To demonstrate differences in insulin levels during OGTT, inflammatory and coagulation parameters, a longer follow-up may be required.