Evolution of metabolic and psychiatric disorders after remission of Cushing

Eva Lau; Joana Oliveira; Sandra Belo; Paula Freitas; AnaIsabel Oliveira; Eduardo Vinha; Ligia Castro; Josue Pereira; Davide Carvaho

doi:10.1530/endoabs.37.EP769

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Endocrine Abstracts (2015) 37 EP769 | DOI: 10.1530/endoabs.37.EP769

ECE2015 Eposter Presentations Pituitary: clinical (121 abstracts)

Evolution of metabolic and psychiatric disorders after remission of Cushing's disease

Eva Lau ^1, , Joana Oliveira ^1, , Sandra Belo ^1, , Paula Freitas ^1, , AnaIsabel Oliveira ^1, , Eduardo Vinha ¹ , Lígia Castro ³ , Josué Pereira ² & Davide Carvaho ^1,

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¹Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, EPE, Porto, Portugal; ²Neurosurgery Department, Centro Hospitalar São João, EPE, Porto, Portugal; ³Pathological Anatomy Department, Centro Hospitalar São João, EPE, Porto, Portugal; ⁴Faculty of Medicine of University of Porto, Porto, Portugal.

Introduction: Cushing’s disease (CD) is a rare endocrine disorder characterized by endogenous hypercortisolism, which is associated with metabolic and psychiatric disorders. It is essential to understand the impact of normalization of serum cortisol in the evolution of these comorbidities.

Aims: To evaluate the evolution of metabolic and psychiatric disorders after biochemical control of hypercortisolism in patients with CD.

Methods: Retrospective observational study of patients with CD who underwent pituitary surgery between January 1998 and October 2013. Clinical data were evaluated at diagnosis and at the last evaluation of hospital consultation. Remission was defined as normal urinary free cortisol and normal plasma cortisol after overnight or low-dose dexamethasone suppression test.

Results: Forty-five patients were included: 87% (n=39) females, mean age 38.2 (12.9) years and mean follow-up period 90.4 (56.7) months. After pituitary surgery, remission of CD was observed in 73.3% (n=33). Recurrence of CD was detected in 30.3% (n=10) of those patients after a mean of 64.4 (36.0) months after the first intervention. At diagnosis, 65.8% were hypertensive, 31.7% diabetic, 41.5% had dyslipidemia, and 46.3% psychiatric disorders. Of the 41 patients in remission at the last evaluation: 29.1% were under the same number of antihypertensive drugs, 20.8% discontinued them, 20.8% reduced their number, 16.7% remained without medication, and 12.5% increased; remission of diabetes occurred in 15.3% of patients and 80% of those who initially were on insulin suspended it; the anti-dyslipidaemic therapy was discontinued in 11.8% and psychotropic drugs were suspended in 55.5%. The mean initial BMI was 32 kg/m² and no significant differences regarding BMI were found after biochemical control of hypercortisolism. However, 46% of patients had a reduction in BMI class.

Conclusion: Biochemical control of hypercortisolism seems to improve the associated metabolic and psychiatric disorders in CD. However, as it is not possible to predict the evolution of these comorbidities it is mandatory an appropriate follow-up, evaluation and treatment of these patients.