Endocrine Abstracts

Recent evidence suggests that resolution of hypercortisolism in Cushing’s disease (CD) may not lead to complete remission of the clinical abnormalities associated with this condition. In particular, elevated cardiovascular risk may persist in ‘cured’ CD patients long-term after eucortisolism has been achieved. This is believed to be related with the maintenance of visceral obesity and altered adipokine secretory pattern which perpetuate features of metabolic syndrome, including impaired glucose tolerance, hypertension, dyslipidemia, atherosclerosis and hypercoagulability. Nephrolithiasis and incomplete recovery of bone mineral density have also been described in CD patients in remission. Moreover, previous exposure to excess cortisol may have irreversible effects on the structures of the central nervous system controlling cognitive function and mood. Thus, sustained deterioration of the cardiovascular system, bone remodelling and cognitive function along with neuropsychological impairment might be associated with high morbidity and poor quality of life in CD patients in remission for many years.

Furthermore, relapse of hypercortisolism is not infrequent, occurring in up to 66% of patients within 10 years from successful surgery. This exposes the patients to the deleterious effects of glucocorticoid excess again.

Life-long monitoring is mandatory in CD patients to diagnose recurrence, control long-term complications of previous cortisol excess and, possibly, normalize life expectancy.