Introduction: Cushings disease (CD) is associated with metabolic and cardiovascular comorbidities that can be incompletely resolved after disease remission. Our objective was to evaluate the metabolic and cardiovascular status of patients with MC in remission
Patients and methods: We performed a retrospective study including 15 CD patients cured by pituitary surgery. Patients medical records were reviewed and information regarding blood pressure and metabolic abnormalities were collected.
Results: The study included 15 patients (10 women; mean age at diagnosis of 34.2±11.3 years) who met the biochemical CD remission criteria after pituitary surgery. Thirteen patients (86.7%) developed adrenal insufficiency. The median duration of glucocorticoid replacement therapy was 28 months (IQR, 12 to 72). At diagnosis, the mean body mass index (BMI) was 28.6±3 kg/m2. Hypertension was present in 12 patients with mean systolic blood pressure (SBP) of 150±26 mm Hg and mean diastolic blood pressure (DBP) of 84±13 mmHg. The metabolic comorbidities were: obesity (7 patients), diabetes (9 patients), hypercholesterolemia (9 patients), and hypertriglyceridemia (9 patients).The mean levels for fasting glucose (FG), total cholesterol (TC), and triglycerides (TG) were 7.67±1.97 mmol/l, 6.16±1.33 mmol/l, and 2.90±2.12, respectively. At the early evaluation (median of 12 months after surgery), many patients had persistent comorbidities: hypertension (8 patients), obesity (4 patients), diabetes (8 patients), hypercholesterolemia (5 patients), and hypertriglyceridemia (5 patients). SBP, FG, and CT significantly decreased but not BMI, DBP, and TG. At the late evaluation (median of 41 months), hypertension was persistent only in 2 patients with significant decrease of both SBP and DBP. Obesity was present in 3 patients, diabetes in 6 patients, hypercholesterolemia in 6 patients, and hypertriglyceridemia in 7 patients. Compared with mean levels at diagnosis, there was no significant difference in FG, CT, and TG means levels at the late evaluation.
Conclusion: After successful surgery, the improvement of cardiovascular and metabolic comorbidities is often incomplete and patients still have increased cardiovascular risk even after long term remission. Lifelong follow-up is necessary to control these persistent comorbidities.
18 - 21 May 2019
European Society of Endocrinology