Cushing’s syndrome: comparison between Cushing’s disease and adrenal Cushing’s

Hirsch, Dania; Shimon, Ilan; Manisterski, Yossi; Aviran-Barak, Nirit; Amitai, Oren; Nadler, Varda; Alboim, Sandra; Kopel, Vered; Tsvetov, Gloria

doi:10.1007/s12020-018-1709-y

Cited by 29 publications

(21 citation statements)

References 25 publications

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“…In recent publications, adrenal adenomas were documented in 5-22.3% of CS cases [25][26][27][28]. In cohort study from Israel, the incidence of adrenal etiology of CS was 38.8% (including the patients with adrenal carcinoma-AC) and was higher compared to our data (we excluded patients with AC) [29]. According to the study from Israel, a growing proportion of diagnosed A-CS relative to P-CS might be attributed to better detection of adrenal mass-incidentalomas [29].…”

Section: Discussioncontrasting

confidence: 72%

Etiology, baseline clinical profile and comorbidities of patients with Cushing’s syndrome at a single endocrinological center

et al. 2020

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The aim of this study was to compare phenotype of patients with pituitary, adrenal and ectopic CS and identify the differences regarding biochemical parameters, clinical presentations, and comorbidities in CS patients who were diagnosed at the single endocrinological center in Wroclaw. Methods The study population involved 64 patients with CS (53 women and 11 men) diagnosed in Department of Endocrinology, Diabetes and Isotope Therapy in 2000-2018. Patients were divided into three etiologic groups: pituitary dependent-CS (P-CS) (64%), adrenal dependent CS (A-CS) (25%), and CS from an ectopic source (E-CS) (11%). Results Percentage of men in the A-CS group was significantly higher than in the other etiologic groups. ACTH, UFC, and cortisol in DST were significantly higher in E-CS group compare to P-CS and A-CS (p < 0.05). Mean potassium level in E-CS group was significantly lower than in P-CS and A-CS (p < 0.05). Median of time elapsed to diagnosis was significantly lower in the E-CS group compared with either the P-CS and the A-CS group (p < 0.01). The most frequently symptoms in CS patients were skin alterations (82.8%), weight gain (81.2%), and hypertension (81.2%). Conclusions The epidemiology of CS is changing toward a growing proportion of A-CS. All patients with E-CS presented a profound hypokalemia. Salient hypokalemia could be a biochemical marker more suggestive for E-CS rather than P-CS. The incidence of diabetes is more frequent in E-CS group than in P-CS and A-CS groups. Keywords Cushing's syndrome • Hypercortisolism • Hypokalemia • Ectopic ACTH syndrome List of abbreviations CS Cushing's syndrome P-CS pituitary dependent CS A-CS adrenal dependent CS E-CS CS from an ectopic source UFC urinary free cortisol CDST cortisol level after overnight 1 mg dexamethasone suppression test ACTH adrenocorticotropic hormone BMI body mass index DM diabetes mellitus IFG impaired fasting glucose SP systolic blood pressure DP diastolic blood pressure LDDST low dose dexamethasone suppression test

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Section: Discussioncontrasting

confidence: 72%

Etiology, baseline clinical profile and comorbidities of patients with Cushing’s syndrome at a single endocrinological center

et al. 2020

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“…Moreover, the total number of baseline comorbidities was not different between pituitary and adrenal cases, despite a higher degree of hypercortisolism in patients with Cushing’s disease (higher UFC values and higher cortisol after 1 mg dexamethasone test). The difference in the degree of hypercortisolism observed between pituitary and adrenal cases appears to depend on the study cohort, as other studies have described also lower and similar UFC levels in patients with Cushing’s disease when compared to adrenal Cushing’s syndrome [ 7 , 10 ].…”

Section: Discussionmentioning

confidence: 90%

“…Among all clinical features accompanying Cushing’s syndrome, weight gain is the most prevalent one and reported in up to 82% of cases, with overweight described in 21–48% and obesity in 32–41% of patients [ 5 – 8 ]. The most prevalent comorbidity is hypertension, which is reported in 50–85% of patients with Cushing’s syndrome, often being also the presenting comorbidity [ 5 – 7 , 9 , 10 ]. Not only the accompanying metabolic syndrome, but also upregulation of the sympathetic nervous system and water retention caused by the mineralocorticoid properties of glucocorticoids play a role in the pathophysiology of glucocorticoid-induced hypertension [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Glucocorticoids impair both insulin secretion and insulin sensitivity, and over time contribute to the failure of beta-cells to adequately enhance insulin secretion compensating for the increased insulin resistance, and therefore to the development of diabetes [ 12 ]. Impaired glucose tolerance is reported in 14–64% of patients with Cushing’s syndrome, diabetes mellitus in 13–47% [ 5 – 8 , 10 ]. Additional prevalent comorbidities include hyperlipidemia, osteoporosis, and depression/psychopathology [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Factors predicting long-term comorbidities in patients with Cushing’s syndrome in remission

et al. 2018

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Purpose In Cushing’s syndrome, comorbidities often persist after remission of glucocorticoid excess. Here, we aim to identify factors predicting long-term comorbidities in patients with Cushing’s syndrome in remission. Methods In a retrospective cross-sectional study, 118 patients with Cushing’s syndrome in remission (52 pituitary, 58 adrenal, 8 ectopic) were followed for a median of 7.9 years (range 2–38) after the last surgery. Associations between baseline anthropometric, metabolic, hormonal parameters at diagnosis, and comorbidities (obesity, diabetes, hyperlipidemia, hypertension, osteoporosis, depression) at last follow-up, were tested by uni- and multivariate regression analysis. Results In patients with manifest comorbidities at diagnosis, remission of Cushing’s syndrome resolved diabetes in 56% of cases, hypertension in 36% of cases, hyperlipidaemia in 23%, and depression in 52% of cases. In a multivariate regression analysis, age, fasting glucose, BMI, and the number of comorbidities at diagnosis were positive predictors of the number of long-term comorbidities, while baseline 24-h urinary free cortisol (UFC) negatively correlated with the persistence of long-term comorbidities. The negative relationship between baseline UFC and long-term comorbidities was also found when pituitary and adrenal Cushing’s cases were analyzed separately. Baseline UFC was negatively related to the time of exposure to excess glucocorticoids. Conclusions Long-term comorbidities after remission of Cushing’s syndrome depend not only on the presence of classic cardiovascular risk factors (age, hyperglycemia, BMI), but also on the extent of glucocorticoid excess. Lower baseline UFC is associated with a higher number of long-term comorbidities, possibly due to the longer exposure to excess glucocorticoids in milder Cushing’s syndrome.

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“…One would hypothesise that clinician review would be likely to improve this, rather than a blanket screening policy. Rapid weight gain as opposed to gradual weight gain, osteoporosis, muscle atrophy, uncontrolled blood glucose and hypertension would all be features that would increase the pre‐test probability of CS …”

Section: Discussionmentioning

confidence: 99%

Patients with morbid obesity should not be routinely screened for Cushing's syndrome: Results of retrospective study of patients attending a specialist weight management service

Glyn

Lambert

et al. 2020

Clinical Obesity

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Cushing's syndrome (CS) is a rare condition which results in multi-system involvement and can lead to significant morbidity and mortality. Screening for CS in patients with obesity has been suggested to identify undiagnosed or occult cases. This study was performed to determine whether CS screening is indicated in a tier 3 weight management centre in the UK. A retrospective review of all patients referred to the weight management service between 2013 and 2016 inclusive was undertaken. A final cohort of 569 patients was obtained. Clinic letters and laboratory databases were used to obtain demographic information, patient characteristics and biochemical results. A total of 387 patients were screened using the 1 mg overnight dexamethasone suppression test (ODST) and 182 patients were screened with two 24-hour urinary free cortisol (UFC) collections. A total of 27 patients had an initial abnormal result, of which 16 underwent further testing and had normal results. Six were reviewed and did not demonstrate any clinical features of CS. Five did not attend their clinic appointments but there were neither concerning features within their referrals, nor subsequent diagnoses of CS made. No patients from this cohort were diagnosed with CS. This study does not support routine CS screening of patients affected by severe obesity referred to a specialist tier 3 weight management service. Clinical assessment should be undertaken first and further investigations performed only if deemed necessary. K E Y W O R D S cortisol, Cushing's syndrome, obesity, screening, tertiary healthcare, weight management

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Cushing’s syndrome: comparison between Cushing’s disease and adrenal Cushing’s

Cited by 29 publications

References 25 publications

Etiology, baseline clinical profile and comorbidities of patients with Cushing’s syndrome at a single endocrinological center

Etiology, baseline clinical profile and comorbidities of patients with Cushing’s syndrome at a single endocrinological center

Factors predicting long-term comorbidities in patients with Cushing’s syndrome in remission

Patients with morbid obesity should not be routinely screened for Cushing's syndrome: Results of retrospective study of patients attending a specialist weight management service

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