Endocrine Abstracts

Introduction: In patients with cured Cushing’s syndrome, comorbidities often persist after remission of glucocorticoid excess. Here we investigate long-term comorbidities in patients with Cushing’s syndrome in remission, and their relationship to metabolic and hormonal markers at the initial diagnosis of the disease.

Methods/design: We evaluated 118 patients with cured Cushing’s syndrome (55 Cushing’s disease, 55 adrenal Cushing’s syndrome and 8 ectopic Cushing’s syndrome) 10 years (range 2–29) after the last surgery. Anthropometric, metabolic, hormonal parameters and comorbidities (obesity, diabetes, hyperlipidaemia, hypertension, osteoporosis, depression) at the last follow-up visit were obtained; baseline data on parameters at diagnosis of Cushing’s syndrome were extracted from hospital records. Uni- and multivariate regression analysis was performed for testing the relationship between baseline factors and long-term comorbidities.

Results: Inpatients with manifest comorbidities at diagnosis, Cushing’s remission resolved diabetes in 54% of cases, hypertension in 34% of cases, hyperlipidaemia in 28% and depression in 48% of cases. Ten (range 2-29) years after the last surgery the prevalences of comorbidities in cured patients were: obesity 16%, diabetes 12%, hypertension 58%, hyperlipidaemia 62%, depression 16% and osteoporosis 21%. In a multivariate regression analysis, age, fasting glucose and depression at Cushing’s diagnosis, were positive predictors of the number of long-term comorbidities, while baseline urinary free cortisol secretion negatively correlated with the persistence of comorbidities in the long-term. The negative relationship between baseline 24-h urinary cortisol secretion and long-term comorbidities was also found when pituitary and adrenal Cushing’s cases were analysed separately.

Conclusions: Long-term comorbidities after remission of Cushing’s syndrome depend not only on the presence of classical cardiovascular risk factors such as age and hyperglycaemia at diagnosis, but also on the amount of glucocorticoid excess. Lower baseline urinary cortisol levels are associated with more long-term comorbidities, possibly due to the delayed diagnosis in milder Cushing’s syndrome leading to a longer exposure to excess glucocorticoids.