Introduction/objective: The objective was to determine if peri-operative levels of DHEAS correlate with levels of ACTH and cortisol and therefore are useful as a new marker for the definition of cure in patients suffering from Cushings disease. DHEAS is an ACTH-dependent precursor of androgens and estrogens secreted from the adrenals. Numerous clinical trials have shown that DHEAS in humans and other mammals is a multi-functional steroid implicated in a broad range of biological effects, including obesity, diabetes, bone metabolism, neuroprotection and anti-tumorigenesis; it has not yet undergone research in the context of Cushings disease.
Methods: Forty-three patients suffering from Cushings disease were treated at our department from September 2009 to February 2011 and were perioperatively monitored for ACTH, cortisol and dehydroepiandrosterol-sulfate (DHEAS).
Preoperative and early postoperative ACTH, cortisol and DHEAS levels were correlated with each other to determine the usefulness of DHEAS as a parameter in patients suffering from Cushings disease.
Results: Forty-three patients were included. All were treated for Cushings disease via a transsphenoidal approach. Pre-operative blood samples were taken on the day before the operation and revealed high normal to elevated levels of ACTH (mean: 104 ng/l), cortisol (mean: 283 μg/l) and DHEAS (mean: 2.59mg/l) according to the pathology of Cushings disease. Postoperative blood checks showed decreased levels of ACTH down to 15.5% (mean: 14.93 ng/l) of its preoperative figure. Cortisol levels were reduced down to 12.5% (mean: 35.39 μg/l) of its preoperative level and DHEA(S) levels decreased down to 19.61% (mean: 0.51 mg/l).
Two patients had decreased levels of all three hormons postoperatively (DHEAS 53.7% and 9%, Cortisol 11.2% and 5.3% and ACTH down to 28.4% and 11.8%), 1 showed elevated levels of DHEAS, ACTH and Cortisol on re-evaluation 5 months after the initial operation and had to undergo a second surgical treatment. The second patient underwent first surgical treatment in 2009 and is currently being re-evaluated as recurrent disease seems highly possible.
Statistical analysis showed a highly significant correlation between changes of ACTH and DHEAS levels and a significant correlation between changes of cortisol and DHEAS levels.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.