ECE2022 Poster Presentations Pituitary and Neuroendocrinology (127 abstracts)
Subtype-specific pattern of white blood cell differential in endogenous Cushing’s syndrome
Mario Detomas 1 , Barbara Altieri 1 , Irina Chifu 1 , Hanna Remde 1 , Laura-Sophie Landwehr 1 , Silviu Sbiera 1 , Matthias Kroiss 1,2 , Martin Fassnacht 1 & Timo Deutschbein 1,3
1University Hospital Würzburg, Würzburg, Germany; 2Klinikum der Universität München, München, Germany; 3Medicover Oldenburg MVZ, Oldenburg, Germany
Objective: Glucocorticoid excess impairs immune function, thereby predisposing patients with endogenous Cushing’s syndrome (CS) to infections. However, it is still not clear whether there is a CS-subtype specific pattern in white blood cell (WBC) and WBC differential (WBCD) count.
Methods: Retrospective monocentric cohort study in patients with either overt endogenous CS or adrenal adenomas with autonomous cortisol secretion (ACS), with WBC and WBCD analysis at initial diagnosis and after remission.
Results: 270 patients (Cushing’s disease (CD), n=88; ectopic CS (ECS), n=31, cortisol-producing adrenal adenoma (CPA), n=39; ACS, n=63; adrenocortical carcinoma (ACC), n=49; were analyzed. Total leukocytes and neutrophils correlated positively with serum cortisol after 1-mg dexamethasone (1 mg-DST) (r=0.346 and r=0.471, respectively, P<0.0001), while a negative correlation was observed for lymphocytes and eosinophils (r=-0.399 and r=-0.519, each P<0.0001). Correlations were confirmed with the 24h-urinary free cortisol (24h-UFC). CD and ECS differed in numbers of neutrophils and lymphocytes (P<0.0001). A cut-off of 6.1 for the neutrophil/lymphocyte ratio (NLR) allowed reliable differentiation between CD and ECS (sensitivity 90.0%, specificity 89.4%, AUC 0.918). NLR allowed a better differentiation between CD and ECS than 1 mg-DST and 24h-UFC (AUC respectively 0.83 and 0.74). Regarding CPA and ACC, a difference in platelet/lymphocyte ratio (PLR) was observed (sensitivity 59.6%, specificity 80.6%, and AUC 0.713 with a cut-off of 187.9). Already 3 months after biochemical remission, neutrophils decreased (delta change -47.0%, -29.7%, and -26.2%) and lymphocytes increased (+123.2%, +78.1%, and +17.7%) substantially (always ECS, CPA, and CD).
Conclsion: Most immune cells correlate with the degree of hypercortisolism but differ also among CS subtypes. WBCD and NLR could allow a first differentiation of ACTH-dependent CS. Normalization of WBCD is observed already after 3 months from CS remission.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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