Cushing

Joanna Witek; Przemyslaw Witek; Grzegorz Zielinski; Marlena Blazik; Grzegorz Kaminski

doi:10.1530/endoabs.37.EP830

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Endocrine Abstracts (2015) 37 EP830 | DOI: 10.1530/endoabs.37.EP830

ECE2015 Eposter Presentations Pituitary: clinical (121 abstracts)

Cushing's disease: reversibility of glucose homeostasis alterations and improvement in insulin resistance indices following a successful, transsphenoidal surgery

Joanna Witek ^1, , Przemyslaw Witek ³ , Grzegorz Zielinski ² , Marlena Blazik ⁴ & Grzegorz Kaminski ³

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¹Diabetes Outpatient Clinic, Institute of the Mother and Child, Warsaw, Poland; ²Department of Neurosurgery, Military Institute of Medicine, Warsaw, Poland; ³Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, Warsaw, Poland; ⁴Paediatric Outpatient Clinic, Warsaw, Poland.

Introduction: Cortisol excess in Cushing’s disease (CD) leads to glucose homeostasis alterations and increased cardiovascular risk.

Aim of the study: i) To assess the reversibility of glucose homeostasis alterations and dynamics of inflammatory and coagulation parameters after the successful transsphenoidal surgery (TSS) for CD. ii) Analysis of the early improvement in insulin resistance (IR) indices following TSS.

Methods: The group consisted of 26 patients (22 women and four men; aged 41.5±13.3) with early remission of CD. 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 TSS. HOMA-IR, QUICKI, and Matsuda indices were calculated. Patients previously diagnosed with diabetes were assessed exclusively for fasting glucose and HbA1c.

Results: Four patients (15.4%) had been diagnosed with diabetes prior to CD confirmation. Five patients (19.2%) were diagnosed with diabetes based on OGTT results prior to surgery. Ten patients (38.5%) were diagnosed with impaired glucose tolerance. A significant decrease in OGTT parameters was confirmed: fasting blood glucose (95.9±17.4 mg/dl vs 83.8±13.4 mg/dl, P<0.05), mean blood glucose (155.4±34.1 mg/dl vs 117.3±21.6 mg/dl, P<0.0001), 60-min glucose (182.6±45 mg/dl vs 135.8±30.6 mg/dl, P<0.001), and 120-min glucose (161.5±52.2 mg/dl vs 118.7±33.9 mg/dl, P<0.05). The Matsuda index and QUICKI improved significantly (2.8±1.8 vs 5.2±3.6, P<0.01 and 0.32±0.03 vs 0.35±0.04, P<0.05 respectively). Three months after TSS decrease in BMI and reduction in waist and hip circumference were not significant. No differences were observed with regards to mean, fasting and 120-min insulin levels, HbA1c, HOMA-IR, hsCRP, D-dimers, and fibrinogen.

Conclusions: i) Three months following successful TSS for CD significant decrease in fasting, mean and 120-min OGTT glucose levels could already be seen. ii) The Matsuda index and QUICKI might be more sensitive IR indices in the early postoperative period compared to commonly used HOMA-IR. iii) To demonstrate improvement in anthropometric parameters, insulin levels during OGTT, inflammatory and coagulation parameters, a longer follow-up may be required.

Disclosure: The studies were partly supported by the grant of Military Institute of Medicine No. 1/8807(258)/2013.