Effects of gender on clinical and biochemical features in Cushing's disease
Marina Cardinaletti, Laura Trementino, Barbara Polenta, Carolina Concettoni, Tatiana Mancini, Marco Boscaro & Giorgio Arnaldi
Cushings disease (CD) occur more frequently in females than in males, but in men this disease seems appear at a younger age and with more severe symptoms and clinical course. Aim of this study was to compare clinical features and biochemical indices of hypercortisolism in male and female patients with CD.
Methods: Forty-five patients (35 females and 10 males) with confirmed CD were analyzed. All patients underwent a complete biochemical and endocrine assessment; in selected case bilateral inferior petrosal sinus sampling (BIPPS) was also carried out.
Results: At diagnosis, males were younger than females (mean age was respectively 33.6±12.8 years vs 42.9±13.4 years). Males presented more severe hypercortisolism with significantly higher ACTH levels, UFC, morning plasma cortisol, midnight plasma cortisol, cortisol after 1 mg dexamethasone suppression test (DST) and cortisol after high-dose DST. No significant differences have been observed between males and females regarding sensitivity and specificity of DST (low and high dose), ACTH and cortisol responses to CRH and DDAVP test and basal and post-CRH ACTH gradient at BIPPS. MRI detected a pituitary adenoma in 88% of patients with a significant prevalence of macroadenomas in males (40% vs 6%). In the other patients the MRI showed no evidence of tumor with a slight prevalence in man. Males patients presented high blood pressure values with higher prevalence of hypertension. The prevalence of osteoporosis and symptomatic fractures were higher in males patients compared with females. Conversely, no differences between sexes were found in BMI, fasting glucose, cholesterol and triglycerides.
Conclusion: Our study confirms that male patients present a CD at younger age with a more florid clinical presentation and a severe hypercortisolism; this finding might be at least due to a more prevalence of ACTH-secreting macroadenoma in these patients.