ECE2023 Oral Communications Oral Communications 11: Late Breaking (6 abstracts)
Persistence of mild hypercortisolism in patients with Cushing’s disease treated with cortisol-lowering drugs : the Haircush study
Fafin Manon 1 , Kamel Mohammedi 2 , Jérome Bertherat 3 , Gerald Raverot 4 , Delphine DRUI 5 , Reznik Yves 6 , Frederic Castinetti 7 , Philippe Chanson 8 , Rouvray Corentin 2 , Galioot Amandine 2 , Julie Brossaud 2 & Antoine Tabarin 1
1CHU Bordeaux, Endocrinology, Pessac, France; 2CHU Bordeaux, Biology, Bordeaux, France; 3CHU Cochin, Endocrinology, Paris, France; 4HC Lyon, Endocrinology, Lyon, France; 5CHU Nantes, Endocrinology, Nantes, France; 6CHU Caen, Endocrinology, Caen , France; 7Assistance Publique Hopitaux, Endocrinology, Marseille, France; 8CHU Bicetre, Endocrinology, Le Kre mlin-Bicetre, France
Background: Medical treatment with cortisol-lowering drugs is commonly used following pituitary surgical failure or recurrence of hypercortisolism in patients with Cushing’s disease (CD). Studies using late-night salivary cortisol (LNSF) measurement have shown persistent disruption of the circadian secretion of cortisol despite normalization of UFC in a subset of medically treated CD patients. Study aim Our objective was to assess the long-term cortisol exposure in CD patients medically treated using hair-cortisol (HF) and hair-cortisone (HE) measurement.
Study design: The Haircush multicenter prospective study included three groups (G) of females with a history of CD: G1=16 patients with normal UFCs following medical treatment with a stable drug dosage of osilodrostat, metyrapone, ketoconazole, pasireotide or cabergoline; G2=13 control patients in remission following pituitary surgery and with a normal pituitary-adrenal function; G3=15 control patients receiving stable recommended doses of hydrocortisone (15-25 mg/d) following bilateral adrenalectomy (BLA). Patients were evaluated during 3 months with their usual treatments. Two late-night saliva and 24 h urine samples were collected in G1 patients every month and only at the end of the study end in G2 and G3 patients. A clinical examination and 3-cm hair sample was collected at the end of the study in all patients. The outcome measures were a clinical Cushing’s score and centralized measurements of HE, HF, LNSF and late-night salivary cortisone (LNSE), and UFC using LC – MS/MS.
Results: Despite having almost all UFCs within the normal range, G1 patients had increased HE concentrations as compared to G2 controls (P=0.003). G1 patients also had increased clinical score (P=0.001), UFC (P=0.03), LNSF and LNSE (P=0.0001) and increased variability in the latter parameters (P=0.004). G3 patients with BLA had increased HF (P=0.002) and HE (p = 0.003) compared to G2 controls contrasting with similar LNSE. Six of the 15 G1 patients exhibited increased HE concentrations above the range of G2 controls and had increased requirement of antihypertensive drugs compared to G1 patients with normal HE (P=0.05).
Conclusion: A single HE measurement identifies chronic mild persistent hypercortisolism in a subset of medically-treated CD patients despite normalized UFCs. Persistent hypercortisolism was at least partly due to an altered circadian rhythm of free serum cortisol. HE could replace multiple saliva and urine analysis to assess the control of hypercortisolism in medically treated CD patients once UFC is normalized. Our results also suggest that patients treated with BLA should receive lower hydrocortisone dosage than that usually prescribed.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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