Older Cushing’s patients more likely to need long-term steroids after surgery
Those 45 or older often require hormone support for 20 months or longer
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Patients who are 45 or older when they have surgery for Cushing’s disease are more likely to need long-term hormone replacement therapy, according to a new study.
Researchers found that prolonged medication use, lasting 20 months or more, is associated with lower survival odds for those with pituitary-driven Cushing’s. Interestingly, this link did not apply to other forms of Cushing’s syndrome, a broader term encompassing other disorders marked by high cortisol levels.
By highlighting the roles of age and immune markers, the study provides clinicians with a way to predict recovery trajectories and use routine blood tests to identify patients who may need extra support.
“We believe that our study provides new insight into real-world patterns of [glucocorticoid] replacement and long-term outcomes in [Cushing’s syndrome],” researchers wrote.
The study, “Age and hematologic parameters can predict prolonged glucocorticoid replacement after remission of cushing disease and adrenal Cushing’s syndrome: A nationwide cohort study,” was published in Pituitary.
How Cushing’s disease impacts the body and brain
Cushing’s disease is a hormonal disorder caused by a tumor in the pituitary gland, a tiny structure located in the brain. This tumor secretes a signaling molecule that prompts the adrenal glands above the kidneys to produce excessive amounts of cortisol, often called the stress hormone. High cortisol levels eventually drive the wide range of symptoms seen in Cushing’s.
The primary treatment is surgery to remove the pituitary tumor. While surgery can cure the disease, it causes cortisol levels to plummet, which can be dangerous. To manage this, doctors prescribe glucocorticoids, medications that mimic cortisol, to keep cortisol levels within normal ranges until the body’s natural cortisol production normalizes.
The time it takes for natural hormone production to return varies from a few months to several years. In this study, researchers analyzed data from 103 patients with Cushing’s disease or other forms of Cushing’s syndrome to determine why some people recover faster than others. They divided patients into two groups: those who needed glucocorticoid therapy for less than 20 months and those who needed it for 20 months or longer.
Age emerged as the most significant predictor. Most patients who recovered quickly were younger than 45. In contrast, those 45 or older typically required treatment for at least 20 months.
Immune cell levels also played a role. Patients with lower levels of neutrophils, a specific type of white blood cell, were more likely to require long-term therapy. The ratio of neutrophils to other immune cell types was also a significant predictor of treatment duration.
“These results suggest that routinely available [blood tests] may help identify patients at risk for prolonged [glucocorticoid] dependency,” the researchers wrote.
The specific type of medication prescribed may also influence the speed of recovery. Most study participants took a glucocorticoid called prednisone, and these patients were generally less likely to need prolonged treatment than those taking hydrocortisone.
Longer therapy duration linked to survival outcomes
For patients specifically diagnosed with Cushing’s disease, the duration of therapy was linked to survival. During the follow-up period, three patients who required long-term hormone replacement died, while no deaths occurred in the group with shorter treatment times.
This difference in survival outcomes was not found in patients with other forms of Cushing’s syndrome, which the researchers said indicates “that the duration of postoperative [glucocorticoid] replacement may not independently predict mortality across all [Cushing’s syndrome] patients.”
The researchers believe these insights can help doctors offer more personalized care and better predict a patient’s recovery path. However, they emphasized that because the study was relatively small, more research is needed to confirm these findings.
