Background: Cushings disease is defined as ACTH dependent pituitary Cushings syndrome and is rare with an estimated incidence of 525 per million/year. Polycystic ovary syndrome (PCOS) is a heterogenous disorder affecting up to 10% of women in the reproductive age and shows clinical overlap with Cushings syndrome (obesity, hirsutism, cycle abnormalities, etc). An increased frequency of Cushings syndrome in selected patient groups has been postulated previously but is unknown in patients with PCOS.
Patients: Three hundred and seventy-eight patients with PCOS according to the Rotterdam criteria were included in the study. All patients received a clinical and laboratory evaluation including ACTH and basal cortisol levels. In case of abnormal parameters, further investigations were performed including Dexamethason suppression test, 24 h urine secretion of cortisol, midnight salivary cortisol levels and imaging studies.
Methods: Clinical study, biochemical, functional and imaging studies.
Results: In 4 out of 378 patients, autonomous overproduction of cortisol was detected. Subsequent investigations revealed a pituitary tumor in all four of these patients. The affected patients underwent hypophyseal surgery with curative effect on the hypercortisolemia and improvement of associated hormonal and metabolic disturbances.
Conclusions: A frequency of 4/378 (1.05%) for Cushings disease in the PCOS patient group is much higher than the expected frequency in the general population. We propose that Cushings syndrome is much more common in PCOS than previously supposed. The current criteria for PCOS establish the diagnosis only if other endocrine disorders have been excluded. This implies careful exclusion of autonomous cortisol overproduction in all patients with PCOS in order to detect a potentially curable underlying disease.
03 - 07 May 2008
European Society of Endocrinology