TOPLINE:

Surgical remission of endogenous hypercortisolism produced greater reduction or remission of cardiometabolic comorbidities — hypertension, diabetes, hyperlipidemia, and obesity — in patients with Cushing syndrome than in those with mild autonomous cortisol secretion. Higher biochemical severity scores at baseline were associated with a greater likelihood of reduction or remission of some of these comorbidities.

METHODOLOGY:

• Patients with Cushing syndrome or mild autonomous cortisol secretion have high rates of hypertension, dysglycemia, hyperlipidemia, and obesity; although surgical removal of the culprit lesion to reverse hypercortisolism is the recommended first-line treatment, evidence on how cardiometabolic conditions evolve after surgical remission remains limited.
• Researchers conducted a prospective single-center cohort study of 357 patients (median age at diagnosis, 53 years; 81% female) with endogenous hypercortisolism who achieved surgical remission to assess its impact on cardiometabolic comorbidities.
• In this cohort, 49% of patients had mild autonomous cortisol secretion, 36% had pituitary Cushing syndrome, 10% had adrenal Cushing syndrome, and 5% had ectopic Cushing syndrome.
• Changes in the severity of hypertension, diabetes, hyperlipidemia, and obesity were assessed at baseline and 3 and 12 months after remission.
• Factors associated with reduction or remission of comorbidities were also studied.

TAKEAWAY:

• At 12 months, a greater proportion of patients with Cushing syndrome than those with mild autonomous cortisol secretion experienced remission or reduction of comorbidities, including hypertension (70% vs 51%), diabetes (90% vs 37%), obesity (79% vs 20%), and elevated levels of non-high-density lipoprotein cholesterol (41% vs 17%).
• Higher biochemical severity scores at baseline were associated with a greater likelihood of reduction or remission in hypertension (odds ratio [OR], 1.28), diabetes (OR, 2.48), and obesity (OR, 1.46) at 12 months after surgery (P < .001 for all).
• A higher clinical severity score at baseline was associated with a greater likelihood of reduction or remission of hypertension and obesity, but not of dysglycemia, at 12 months.
• The type of glucocorticoid therapy used after surgery did not predict reduction or remission of cardiometabolic comorbidities.

IN PRACTICE:

“In this prospective cohort study, we showed that hypertension, dysglycemia, elevated non-HDL [non-high-density lipoprotein] cholesterol, and obesity improve in a significant proportion of patients with CS [Cushing syndrome] and MACS [mild autonomous cortisol secretion], though more prominently in patients with Cushing syndrome,” the authors of the study wrote.

SOURCE:

The study was led by Shireen R. Chacko, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota. It was published online inThe Journal of Clinical Endocrinology & Metabolism.

LIMITATIONS:

Patients were followed by individual physicians, leading to nonstandardized frequency and methods of cardiometabolic assessments. Additionally, documentation of medication use may not have reflected actual patient adherence. Follow-up timing was not standardized, causing variability in the dates of the first and second postsurgical visits.

DISCLOSURES:

The study was partially supported by a philanthropic gift from Lili and Keith Olin supporting patients with Cushing syndrome and by a grant for investigator-initiated research supporting Cushing syndrome from Recordati Rare Diseases Inc. Some authors reported participating on data safety monitoring boards and advisory boards, consulting with fees paid to their institutions, and receiving institutional funding for investigator-initiated research; one author is being a named inventor on licensed intellectual property, serving as an investigator on multiple trials, and holding consulting contracts and stock in a company.

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