Anemia in male patients with cushings syndrome before and after cure
Francesca Pecori Giraldi, Paola Ascoli, Martina De Martin, Nicoletta Polli & Francesco Cavagnini
Glucocorticoids are known to exert a stimulatory action on white blood cell precursor proliferation but little is known on erythrocyte counts in patients with Cushings syndrome.
Aim: Of the present study was to assess red and white blood cell parametres in a large series of patients with Cushings syndrome and follow the blood cell changes after postsurgical remission or persistence of hypercortisolism.
Methods: Of 84 patients with Cushings syndrome (67 women, 17 men, age 38.9±9.98 year) were evaluated prior to surgery and for up to 257 months (mean 47.7±2.6 months) after pituitary/adrenal surgery.
Results: Leukocytosis (>9000/mm3) was detected in 46% of patients with Cushings syndrome; leukocyte counts fell promptly after remission of disease (9800±350 vs 7200±130/mm3 in cured patients, P<0.05; 9280±81 vs 8050±210/mm3 in surgical failures, NS) with a consistent drop in neutrophils (68.9 vs 54.5%, P<0.05) and slight increase in eosinophils (1.1 vs 2.4%, P<0.05) compared with presurgical values. Red blood cell counts were in the upper normal range in women with Cushings syndrome (Hb 13.7±0.17 g/dl; RBC 4.5±0.65×106/mm3) whereas, unexpectedly, male patients presented with low-normal hemoglobin (14.4±0.22 g/dl) and RBC (4.5±0.13×106/mm3) and four patients were frankly anemic (Hb <13 g/dl). Surgery per se was followed by a decrease in Hb levels by 1.52 g/dl, regardless of surgical outcome. Women cured of Cushings syndrome rapidly restored and stabilized their Hb levels around 13.2±0.19 g/dl whereas a longer time (up to 3 years) was necessary to achieve normal RBC counts in cured men. Indeed, mean Hb levels in the middle quartiles of the normal range (15.2±0.31 g/dl) were observed on average 36 months after surgery. The recovery of RBC appeared independent of replacement therapy and was correlated to testosterone levels (r=0.349, P<0.05).
Conclusions: Male patients with Cushings syndrome present relatively low RBC counts, possibly linked to the attendant hypogonadism, which resolve over time after surgery. This study highlights yet another unfavourable feature of men with Cushings syndrome (Pecori Giraldi JCE&M 88:15541558, 2003).