TOPLINE:

Following curative surgery for Cushing's syndrome (CS), patients experienced a transient but marked deterioration in lipid profiles during the early postoperative remission phase. These changes were often worse than lipid abnormalities during active disease and were associated with postoperative low-grade inflammation.

METHODOLOGY:

• Researchers conducted a monocentric, longitudinal, observational cohort study to assess lipid profiles during the early postoperative remission phase in patients with endogenous CS.
• They included 26 patients (median age, 42 years; 77% women) who achieved complete biochemical remission after curative surgery, including 17 who underwent transsphenoidal surgery and nine who underwent adrenalectomy, and 26 matched control participants without hypercortisolism (median age, 43 years; 77% women).
• Lipid profile components — including total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), apolipoprotein A1 (ApoA1), apolipoprotein B, lipoprotein(a), triglycerides, and non-esterified fatty acids — were measured preoperatively and at 1, 3, 6, 12, and 24 months postoperatively.
• Associations between the triglyceride-glucose (TyG) index and levels of inflammatory markers, C-reactive protein and interleukin-6, were assessed.

TAKEAWAY:

• At baseline, no significant differences in total cholesterol levels, LDL levels, triglyceride levels, or the TyG index were observed between patients with active disease and control participants.
• During the early postoperative remission phase (months 1-6), HDL and ApoA1 levels at 1 month after surgery declined compared with preoperative levels; total cholesterol and LDL levels showed transient improvements within the first 3 months following surgery.
• Over 12-24 months postoperatively, LDL levels returned to preoperative values, whereas HDL levels improved steadily, surpassing preoperative values at 24 months. Total cholesterol levels remained lower than baseline values for up to 1 year after surgery, and lipoprotein(a) levels remained unchanged throughout the follow‑up period.
• Triglyceride levels increased markedly at 1 month following surgery compared with preoperative levels. The TyG index increased at 1 month postoperatively and showed no substantial improvement over 24 months. The TyG index was positively associated with C-reactive protein levels at 1 month, 3 months, and 6 months and with interleukin-6 levels at 3 months (P < .05 for all).

IN PRACTICE:

"Our findings suggest that lipid profiles should be carefully monitored in the early postoperative period as CS patients belong to a high-risk group. Decisions regarding lipid-lowering therapy should be individualized and based on overall cardiovascular risk and current guideline recommendations," the authors wrote.

SOURCE:

This study was led by Moritz Schrenk, Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany. It was published online on April 24, 2026, in The Journal of Clinical Endocrinology & Metabolism.

LIMITATIONS:

The possibility of false-positive findings could not be fully excluded. Surgery may have affected postoperative lipid profiles. The control group was BMI-matched and consisted of participants with overweight, with some individuals meeting criteria for metabolic syndrome.

DISCLOSURES:

This study received support from Else Kröner-Fresenius Stiftung and other sources. Two authors declared receiving speaker honoraria, advisory board fees, and/or consulting fees from various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.