Psychiatric ills continuing risk with Cushing’s, despite tumor surgery
Higher rate of post-surgical complications seen with chronic high cortisol levels
People with Cushing’s disease are at an increased risk of complications, particularly psychiatric disorders requiring hospitalization, even after the disease-causing tumor has been surgically removed, a study indicates.
Its findings “support the need for comprehensive clinical evaluation and tailored interventions for [Cushing’s disease] patients, even post-surgery,” the researchers wrote.
The study, “Longterm-outcomes in patients with Cushing’s disease vs. non-functioning pituitary adenoma after pituitary surgery: An active-comparator cohort study,” was published in Clinical and Translational Endocrinology From Around the Globe.
Surgery to remove a pituitary tumor is main Cushing’s disease treatment
Cushing’s disease is caused by a tumor in the pituitary gland, located at the base of the brain. The pituitary tumor drives excessive production of the stress hormone cortisol, and high cortisol levels ultimately drive disease symptoms.
Surgery to remove this tumor is a main, first-line treatment for Cushing’s disease. Some studies have suggested that, even after the tumor is removed, Cushing’s patients can be at a heightened risk of health problems due to the toll of chronic high cortisol levels on the body. But other studies show conflicting results.
Interpreting these data is particularly complicated because it can be hard to tease out the effects of chronic cortisol exposure from the effects of the pituitary tumor itself.
Researchers in Switzerland compared long-term outcomes after surgery for people with Cushing’s disease and those with non-functioning pituitary adenoma (NFPA), which refers to a pituitary tumor that doesn’t cause elevated cortisol levels.
“Evidence for the overall burden of complications after pituitary surgery is still poor. Hence, the findings from this study are expected to enhance our understanding of the range of complications that could arise, even following surgical interventions,” the scientists wrote.
Their analysis included data covering 116 Cushing’s disease patients and 396 people with NFPA. The two groups were similar in terms of age and sex, nationality, healthcare insurance level, type of care facility, and type and time of surgery. The median follow-up time for both groups was more than four years after surgery.
More than 3 times higher risk of hospitalization for psychiatric issues seen
Results showed that the risk of complications after surgery was 2.75 times higher in Cushing’s disease patients than in those with NFPA. Complications in this analysis included death due to any cause, major heart complications, hospitalizations for psychiatric disorders, sepsis (an extreme and potentially life-threatening reaction to an infection), severe clotting problems, and fractures needing hospitalization.
However, when each of these outcomes was measured separately, only the risk of hospitalization for psychiatric disorders was significantly higher — by more than three times — in Cushing’s patients.
A risk of sepsis also tended to be higher in Cushing’s disease patients, but this difference didn’t reach statistical significance, meaning it’s plausible the trend was due to random chance. Cushing’s disease patients also tended to have longer hospital stays following surgery than those with NFPA.
The risk of other complications, including death, was similar in both groups, though the researchers noted that the small number of patients who experienced such outcomes made it difficult to draw robust conclusions.
“Results spanning up to a decade revealed an increased rate of adverse outcomes in [Cushing’s disease] patients, persisting post-surgery, driven primarily by elevated rates of hospitalization for psychiatric disorders and sepsis. Other long-term outcomes of interest did not exhibit substantial differences between the groups,” the researchers concluded.
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