Simple blood tests may help doctors monitor Cushing’s disease
Study links high cortisol to changes in blood counts
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A study tied high cortisol in Cushing’s disease to an increase in certain blood cells not explained by the presence of the disease-causing tumor, suggesting that simple blood tests may help doctors monitor patients and their response to treatment.
“Routine complete blood counts may serve as accessible biomarkers for monitoring disease activity and treatment response,” researchers wrote in the study, “Hematological changes in Cushing’s disease from diagnosis to remission: comparison with non-functioning pituitary adenomas,” published in Endokrynologia Polska, the journal of the Polish Society of Endocrinology.
Cushing’s disease is caused when a pituitary adenoma — a tumor that forms in the brain’s pituitary gland — produces and releases excess adrenocorticotropic hormone (ACTH), which signals the adrenal glands to produce cortisol. High cortisol, known as hypercortisolism, can result in a range of Cushing’s symptoms, such as high blood pressure and weight gain.
While earlier studies have suggested that Cushing’s can alter blood counts, these have mainly compared patients with healthy individuals, making it difficult to determine whether the changes were caused by high cortisol or other factors. This study instead compared people with Cushing’s to those with a non-functioning pituitary adenoma, a tumor that does not produce excess ACTH.
Study measures cell counts
The study involved 117 patients: 59 diagnosed with Cushing’s and 58 with non-functioning pituitary adenomas. Most patients in both groups were women. All underwent transsphenoidal adenomectomy, a surgery to remove a pituitary tumor. Blood tests, including a complete blood count, were performed before the surgery and again three months afterward.
Before the surgery, people with Cushing’s had higher numbers of white blood cells, including neutrophils, than people with a non-functioning pituitary adenoma. White blood cells are immune cells that help protect the body against infection, and neutrophils are the first white blood cells to respond to infection. Their neutrophil-to-lymphocyte ratio, a measure of inflammation, was also higher.
Patients with Cushing’s had higher red blood cell counts than those with a non-functioning pituitary adenoma, but fewer eosinophils, white blood cells involved in allergic reactions. There were no significant differences in the complete blood count of men and women with Cushing’s before the transsphenoidal adenomectomy.
Three months after surgery, patients with Cushing’s had significant decreases in white blood cell and neutrophil counts, neutrophil-to-lymphocyte ratio, and hemoglobin, the protein that carries oxygen in red blood cells. Eosinophils tended to increase. These findings suggest that changes linked to high cortisol can improve after treatment.
Of the 55 patients with Cushing’s who were fully evaluated for remission, 39 (70.9%) achieved biochemical remission, meaning the body was no longer exposed to high cortisol. Sixteen patients (29.1%) did not achieve biochemical remission. Patients who achieved biochemical remission had larger decreases in white blood cells and neutrophils and larger increases in eosinophils, suggesting the changes are reversible with treatment.
“To the best of our knowledge, this is one of the few studies that directly compares longitudinal hematological changes in patients with [Cushing’s disease] and [a non-functioning pituitary adenoma] who undergo the same surgical procedure, thereby allowing differentiation of hypercortisolism-specific effects from tumor- and surgery-related alterations,” the researchers wrote.
Thomas Larry Smith
It is no surprise that elevated cortisol results in an elevated neutrophil count. Every medical student learns that treatment with corticosteroids creates neutrophilia .