Endocrine Abstracts

Introduction: Cushing’s syndrome (CS) is associated with a plethora of metabolic consequences. Current literature regarding the impact of different aetiologies on metabolic complications is scarce, and results are inconsistent. More studies are needed to validate previous findings.

Aim and methods: In order to compare the outcomes of pituitary and adrenal CS, we conducted an observational retrospective study, investigating the medical records of 72 patients diagnosed with CS between 2010-2021. Mean time of follow-up was 5.53±4.27 years (median 5 years).

Results: We included 35 patients (91.4% females) with pituitary CS and 37 (83.7% females) patients with adrenal CS. Patients with Cushing’s disease were diagnosed at a younger age (37.77±13.04 vs 53.49±13.33 years, P <0.01) and were more likely to present with clinical signs of hypercortisolism, including central obesity, hirsutism, and purple striae (P=0.002). At diagnosis, cortisol levels, evaluated by early morning and midnight serum cortisol, were similar between our groups (p value was 0.61 and 0.07) and there were no statistically significant differences regarding body mass index, systolic and diastolic blood pressure, lipid profile, fasting plasma glucose, glycated haemoglobin and personal history of arterial hypertension, type 2 diabetes, or osteoporosis. Neither lumbar nor femoral bone mineral density and T scores differed between the two aetiologies. Comparing datasets from first admission with their recent counterparts, a significant reduction in systolic blood pressure was found (134.14±19.29 vs 121.66±14.87 mmHg, P=0.01) in patients with Cushing’s disease, while their diastolic blood pressure was stationary. In patients with adrenal adenoma, this reduction was not significant (140.33±25.54 vs 132.86±18.47 mmHg, P=0.06), although the groups were similar in terms of active disease (P=0.176) and use of antihypertensive medication (P=0.722).

Conclusions: In line with previous studies, Cushing’s disease is diagnosed at an earlier age and is more frequently associated with clinical signs of hypercortisolism as opposed to adrenal CS, despite similar cortisol levels. Conversely, the impact on glucose, lipid and bone metabolism appears to be comparable in these groups. Systolic blood pressure seems less likely to improve overtime in adrenal vs pituitary Cushing’s syndrome.