Surgery for Cushing’s disease more effective than medication: Study
But some problems, like obesity, high blood pressure, can remain
Surgery for Cushing’s disease eases symptoms and improves heart health more effectively than medication, a new study by researchers at the University Hospital of Padova in Italy has found.
However, some problems — specifically including obesity and high blood pressure — can still remain, especially if cortisol is not properly controlled at night, the results showed.
“Surgical remission leads to faster and sustained improvements in clinical phenotype,” or observable disease characteristics, among patients, the team wrote, noting, however, that symptoms like obesity and hypertension, or high blood pressure, “do not completely revert in five years, especially during [continuing] medical treatment.”
According to the researchers, the findings of this study “[underline] that all the comorbidities [co-occurring conditions] … must be intensively treated” regardless of surgery decisions.
The study, “Cardiometabolic complications after Cushing’s disease remission,” was published in the Journal of Endocrinological Investigation.
Surgery is first-line treatment for Cushing’s disease
Cushing’s disease is caused by a tumor in the brain’s pituitary gland. Such pituitary tumors can produce and release high levels of a hormone that signals the adrenal glands atop the kidneys to produce cortisol. An excess of cortisol can result in symptoms of Cushing’s disease.
The first-line treatment for Cushing’s disease is transsphenoidal surgery — a surgical procedure to remove the pituitary tumor. If this does not fully eliminate disease symptoms or if they return, doctors often use medication to keep cortisol levels under control. However, even after cortisol returns to normal, some issues may persist.
In this study, the team of researchers compared how well surgery works in keeping cortisol levels under control, versus medication, over the long term. The study involved 60 people with Cushing’s disease. Remission after surgery was defined as having normal cortisol levels in the urine, combined with having less than 50 nmol/L of cortisol in the blood in the first month, and having to take corticosteroids to replace those that the body no longer produced.
A total of 36 individuals who had transsphenoidal surgery were followed alongside 24 patients on long-term medical therapy. All had achieved remission and maintained normal cortisol levels in the urine. They were followed for at least two years, with some — 32 patients from the surgery group and 11 from the medication group — being followed for five years.
While both groups had normal cortisol levels in the urine, patients being treated with medication showed more persistent physical symptoms for up to five years. Among such symptoms were redness in the face, a buildup of fat on the upper back, and easy bruising.
Both groups, however, experienced persistent obesity and muscle weakness, especially those with high late-night cortisol levels in saliva, the researchers noted.
Within [two] years, patients in the surgical remission group showed a marked improvement of all [disease] traits common at [Cushing’s disease] diagnosis compared to those in medical therapy.
Fewer patients had hypertension two years after having surgery (44% vs. 64%) or being in long-term medical treatment (71% vs. 75%), but the reduction was greater in the surgery group.
The prevalence of diabetes was similar in both the surgery and the medical treatment groups after two and five years, the data showed. Patients with diabetes tended to have persistently high late-night cortisol levels in saliva.
“Within [two] years, patients in the surgical remission group showed a marked improvement of all [disease] traits common at [Cushing’s disease] diagnosis compared to those in medical therapy,” the researchers wrote.
At the start, abnormal levels of fatty molecules in the blood, called dyslipidemia, were as common in the surgery group as it was in the medication group. However, after five years, it was more common in the medication group (91% vs. 47%).
“Surgical remission results in more rapid and relevant improvements,” the researchers wrote.
These findings also suggest that normal cortisol should not be the only treatment goal, according to the team, noting the “persistence of comorbidities” still requiring medical care.
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