Endocrine Abstracts

JOINT2308

Introduction: The remission of Cushing’s syndrome (CS) is known to improve glycemic control, but the extent and statistical significance of these improvements remain poorly documented. This study aims to quantitatively assess the effect of CS remission on glycemic parameters.

Methods: A cohort of 22 patients with CS was followed from diagnosis to remission. The primary glycemic parameters analyzed were fasting blood glucose (FBG) and glycated hemoglobin (HbA1c), measured before and after treatment. A paired t-test was used to compare pre- and post-remission values. Additional analyses were performed based on baseline glycemic status and the type of treatment received before remission.

Results: The analysis demonstrated a significant improvement in glycemic control following CS remission. On average, fasting blood glucose decreased by 23% (P = 0.001), and HbA1c dropped by 0.9% (P = 0.008). Among diabetic patients (n = 10), fasting blood glucose decreased from 142.6 ± 18.4 mg/dl to 109.2 ± 14.7 mg/dl (P = 0.001), while HbA1c declined from 7.8 ± 1.1% to 6.9 ± 0.9% (P = 0.005). Notably, 50% of these patients achieved normoglycemia post-remission, whereas the remaining half continued to exhibit impaired glucose metabolism. In contrast, non-diabetic patients (n = 12) also experienced significant reductions in glycemic markers. Their fasting blood glucose decreased from 98.7 ± 10.3 mg/dl to 89.4 ± 7.8 mg/dl (P = 0.02). Patients who required insulin therapy before remission (n = 6, 27.3%) exhibited variable responses post-remission. While four patients (66.7%) continued to require pharmacological treatment, those initially managed with oral antidiabetic drugs or lifestyle modifications were more likely to achieve complete glucose normalization. Furthermore, an analysis of baseline cortisol levels revealed a significant correlation with post-remission glycemic outcomes. Patients with persistent hyperglycemia had significantly higher baseline cortisol levels (562.3 ± 91.4 nmol/l vs. 398.1 ± 76.2 nmol/l, P = 0.02) compared to those who achieved normoglycemia.

Discussion: This statistical analysis confirms that CS remission leads to significant improvements in glycemic control, particularly in diabetic patients. However, the degree of improvement appears to be influenced by baseline cortisol levels and disease duration, highlighting the impact of prolonged hypercortisolism on insulin resistance and pancreatic beta-cell dysfunction. Despite overall improvements, some patients remain hyperglycemic post-remission, emphasizing the need for ongoing metabolic follow-up.

Conclusion: Our findings demonstrate that Cushing’s syndrome remission significantly improves glycemic parameters, particularly in diabetic patients. However, persistent hyperglycemia post-remission is associated with higher baseline cortisol levels and pre-existing insulin dependence, suggesting a potential irreversible impact on pancreatic function. Long-term monitoring remains essential to optimize metabolic outcomes in these patients.