Endocrine Abstracts (2009) 20 P39

Anemia in male patients with cushing's syndrome before and after cure

Francesca Pecori Giraldi, Paola Ascoli, Martina De Martin, Nicoletta Polli & Francesco Cavagnini


Department of Endocrinology, Chair of Endocrinology, Istituto Auxologico Italiano, University of Milan, Ospedale San Luca, Milan, Italy.


Glucocorticoids are known to exert a stimulatory action on white blood cell precursor proliferation but little is known on erythrocyte counts in patients with Cushing’s syndrome.

Aim: Of the present study was to assess red and white blood cell parametres in a large series of patients with Cushing’s syndrome and follow the blood cell changes after postsurgical remission or persistence of hypercortisolism.

Methods: Of 84 patients with Cushing’s 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 Cushing’s 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 Cushing’s 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 1.5–2 g/dl, regardless of surgical outcome. Women cured of Cushing’s 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 Cushing’s 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 Cushing’s syndrome (Pecori Giraldi JCE&M 88:1554–1558, 2003).

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