Endocrine Abstracts

Introduction: Cushing’s syndrome is associated with significant chronic and acute complications including acute thromboembolic and cardiovascular events. We aimed to study the prevalence and predictors of acute and perioperative complications in patients with active Cushing’s syndrome.

Methods: The prevalence, predictors and outcomes of acute, life-threatening and perioperative complications were evaluated in a cohort of patients with active biochemically verified Cushing’s syndrome attending our endocrine department between 1978 and 2016. Any medical complications necessitating hospitalization, including admission to intensive care units (ICUs), from appearance of first symptoms of hypercortisolism until one year after biochemical remission by surgery (or, where surgical remission was not achieved, during continuing follow-up) were recorded and classified. Baseline factors relating to and predicting acute complications were tested using uni- and multivariate analysis.

Results: 242 patients (m/f n = 54/188) with Cushing’s syndrome (pituitary n = 99, adrenal n = 116, ectopic n = 27) were included in this study, 14% of which had malignant disease.

55% of patients experienced at least one acute complication including electrolyte disturbances (24%), infections (28%), thromboembolic events (19%: including 4% with cerebrovascular events, 9% with pulmonary embolisms and 6% with other thromboembolic events), cardiac arrhythmias necessitating medical intervention (5%), hypertensive crises (9%) and acute coronary events (3%).

The number of complications per patient significantly correlated with age, duration of hypercortisolism, severity of hypercortisolism (measured by biochemical parameters such as 24-hours urinary free cortisol – UFC), as well as markers of glucose and lipid metabolism. Multiple regression analysis revealed age at diagnosis, fasting glucose and UFC as independent predictors of the number of acute complications per patient. When patients with malignant disease were excluded from analysis, fasting glucose and UFC remained significant predictors. At least one ICU admission (excluding post-surgical observance) was required in 13% of patients. In the whole cohort as well as when malignant cases were excluded, the number of ICU days per patient was significantly related to age at diagnosis, parameters of glucose metabolism, and UFC, with UFC being an independent predictor of the number of ICU days per patient.

Conclusion: This cohort analysis highlights the high prevalence of acute and perioperative complications in Cushing’s syndrome, with one in eight patients suffering a life-threatening situation necessitating ICU admission. These acute complications are positively predicted by the duration and degree of hypercortisolism, age and metabolic parameters, emphasizing the necessity for acute interventions aiming to reduce cortisol excess even before definitive disease cure is achieved.