Endocrine Abstracts

Cushing’s syndrome (CS) is associated with systemic complications, which despite successful treatment are not always totally reversible. Morbidity like venous thromboembolism, myocardial infarction, stroke, peptic ulcers, fractures and infections are higher in patients diagnosed with CS, both of adrenal and pituitary origin, and remain elevated during long-term follow-up. In fact, this increased multimorbidity risk is even present in the 3 years before diagnosis, as demonstrated in a large population-based cohort study from Denmark, showing how deleterious chronic hypercortisolism is, despite the apparently benign character of CS.

Treatment of concomitant morbidity like hypertension, insulin resistance and/or diabetes mellitus, dyslipidemia, prothrombotic state, vascular disease, atherosclerosis and increased cardiovascular risk, are often necessary and may not be completely normalized despite disappearance of hypercortisolism after successful treatment. Psychologically, patients complain of impaired memory; objectively loss of brain volume can be seen on CT and MRI scans, as well as cognitive decline and impaired health-related quality of life -HRQoL-, which although is worse in active disease, is still below normative values even years after control of hypercortisolism; together, these limitations contribute to the appearance of depression, a common complaint in these ‘cured’ patients.

Mortality is higher than in age- and gender-matched subjects, due to complications directly and/or indirectly correlated with glucocorticoid excess. Altogether, despite being a rare disease, difficulties in early diagnosis and residual morbidity represent a significant burden for the patients and for the health system. Thus, the primary goal in the prevention and treatment of complications of CS is correction of hypercortisolism as soon as possible. Furthermore, patients benefit from long-term follow-up, to promptly identify and treat co-morbidities, and the possibility to discuss their experienced limitations with a professional aware that these may not be completely reversible.