Cushing's Syndrome Etiology Affects Adrenal Function Recovery

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The probability of and time to recovery of adrenal function after a tumor resection in Cushing’s syndrome is dependent on etiology, according to a study published in the Journal of Clinical Endocrinology & Metabolism.

Patients with ectopic Cushing’s syndrome had the highest probability of recovering adrenal function and the shortest time to recovery, reported Martin Reincke, MD, of the Ludwig-Maximilians-Universität München in Germany, and colleagues.

In endogenous Cushing’s syndrome, a successful tumor resection results in tertiary adrenal insufficiency, which then requires hydrocortisone replacement therapy. The researchers sought to determine the duration of postsurgical adrenal insufficiency for patients with Cushing’s disease, adrenal Cushing’s syndrome and ectopic Cushing’s syndrome.

The retrospective analysis included the case records of 230 patients with Cushing’s syndrome with a mean follow-up time of 8 years. Of these patients, 91 underwent curative-intended surgery.

The researchers found that the likelihood of recovering adrenal function within a 5-year follow-up differed significantly depending on which disease subtype the patient had. Patients with ectopic Cushing’s syndrome had an 82% chance of recovering adrenal function; patients with Cushing’s disease had a 58% chance; and patients with adrenal Cushing’s syndrome had a 38% chance. 

The median time to recovery also differed between these subtypes. It was 0.6 years for ectopic Cushing’s syndrome, 1.4 years for Cushing’s disease and 2.5 years for adrenal Cushing’s syndrome.

The probability of recovery was associated with younger age but was independent of other factors, including gender, BMI, duration of symptoms, and basal ACTH and cortisol levels.

Cushing's Syndrome Etiology Affects Adrenal Function Recovery
Cushing’s Syndrome Etiology Affects Adrenal Function Recovery

Results: The probability of recovering adrenal function within a 5 years follow-up differed significantly between subtypes (p=0.001). It was 82 % in ectopic CS, 58 % in Cushing's disease and 38 % in adrenal CS. In the total cohort with restored adrenal function (n=52) the median time to recovery differed between subtypes: 0.6 (IQR 0.03–1.1) years in ectopic CS, 1.4 (IQR 0.9–3.4) years in CD, and 2.5 (IQR 1.6–5.4) years in adrenal CS (p=0.002). In CD the Cox proportional-hazards model showed that the probability of recovery was associated with younger age (hazard ratio 0.896, 95% CI 0.822–0.976, p=0.012), independently of sex, BMI, duration of symptoms, and basal ACTH and cortisol levels. There was no correlation with length and extend of hypercortisolism or postoperative glucocorticoid replacement doses.

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