Top 10 Cushing’s Disease Stories of 2022

Throughout 2022, Cushing’s Disease News has brought you coverage of the latest developments in research and advances in treatment related to Cushing’s disease.

We look forward to continuing to serve as a resource for the Cushing’s community going into 2023. Here is a list of the top 10 most-read articles published this past year.

No. 10 – “Risk of Eye Disorder Seen With Subclinical Cushing’s Syndrome”

Central serous chorioretinopathy, or CSCR, is a rare eye disorder characterized by the buildup of fluid under light-sensing cells at the back of the eye. In this report, researchers described the case of a 50-year-old woman with CSCR that caused blurred vision and spots in her vision. Over the course of the clinical workup, the woman was found to have a tumor in her adrenal gland that was causing subclinical Cushing’s syndrome — a condition that causes cortisol levels to be abnormally high without triggering overt symptoms of Cushing’s. After surgically removing the disease-driving tumor, the patient no longer had fluid accumulation in her eye.

No. 9 – “Psychosis Was 1st Sign of Cushing’s in Woman, 22: Case Report”

Psychosis is defined by hallucinations and/or delusions. While Cushing’s disease often causes mental health issues like depression and irritability, psychosis is rare in people with the disorder. This case report detailed the diagnosis of young woman with psychotic symptoms who was ultimately found to have Cushing’s disease. She had initially sought treatment at a psychiatric facility, yet her symptoms did not ease with standard treatments. Following her Cushing’s diagnosis, and after addressing this underlying disorder in addition to mental health support, she stopped experiencing hallucinations and delusions. Researchers noted that hard-to-treat psychosis can be a first sign of Cushing’s.

No. 8 – “Prolonged Cortisol Exposure Can Affect Long-term Quality of Life”

Many people experience cognitive issues as a symptom of Cushing’s disease, but it has not been clear whether these issues can persist after the disorder is in remission. This study included 25 people with Cushing’s that was in remission and 25 people without Cushing’s, all of whom completed a battery of assessments aiming to evaluate cognition and quality of life. Across cognitive assessments, Cushing’s patients who were in remission performed similarly to those without the disease. Despite this similarity, life quality measures were poorer for Cushing’s patients in remission. Researchers speculated that exposure to high levels of cortisol during periods of active Cushing’s disease might “rewire” the brain in ways that affect life quality, but they stressed a need for further research to validate and expand on these findings.

No. 7 – “Survey: Delayed Diagnosis May Lead to Persistent Symptoms in Cushing’s”

In an effort to better understand the journeys experienced by people with Cushing’s syndrome, researchers conducted a survey of 320 patients across 30 countries. Results showed that nearly half of patients had been experiencing symptoms of Cushing’s for at least two years before being diagnosed with the disorder. Despite treatment, most patients reported that they continued to experience bothersome symptoms of Cushing’s. A parallel survey of healthcare providers suggested that specialists’ perceptions about which symptoms of Cushing’s are most common and bothersome does not always line up with reports from patients.

No. 6 – “Cushing’s Linked to Structural, Functional Changes in Brain’s Hippocampus”

The hippocampus is a brain region that plays critical roles in memory and mood regulation. A team of scientists in China conducted analyses assessing the size of this brain region, as well as how it was interconnected with other brain regions, in 47 Cushing’s patients and 53 people without the disease, who served as controls. Cushing’s patients were found to have smaller volumes in all parts of the hippocampus that were assessed, as well as connectivity abnormalities in this area of the brain. Some differences in brain connectivity showed statistical associations with life quality measures among the patients. According to researchers, these findings highlight the damaging effects of excessive cortisol levels in the hippocampus, and shed light on the underlying causes of Cushing’s cognitive and mood symptoms.

No. 5 – “FDA Approves Recorlev for Adults With Endogenous Cushing’s”

Recorlev (levoketoconazole) is an oral therapy that works by blocking cortisol production. Just before the end of 2021, Xeris Biopharma Holdings, which markets the therapy, announced the U.S. Food and Drug Administration (FDA) had approved Recorlev to treat adults with endogenous Cushing’s syndrome. The therapy is indicated for patients who aren’t eligible for surgery, or who continue to experience symptoms despite surgery. The FDA approval was supported by clinical trial data showing the therapy can lower cortisol levels and ease symptoms. Recorlev was commercially launched in the U.S. in late January.

No. 4 – “Study Focuses on Eyelid Edema as ‘Under-recognized’ Cushing’s Sign”

Cushing’s syndrome can cause edema (swelling) in the eyelids, but this symptom has rarely been documented in reports outside of Japan. While this case report also involved a patient in Japan, researchers suggested eyelid edema might be a diagnostic clue to help alert clinicians to the possibility of Cushing’s. Here, a 49-year-old woman had sought medical attention due to weight gain and lack of menstrual cycles. Marked eyelid edema was seen on clinical examination, and the woman was ultimately diagnosed with Cushing’s. The researchers called eyelid edema “an under-recognized sign” of the disease.

No. 3 – “Combining Cortisol Blockers May Lead to Better Control in Cushing’s”

Steroidogenesis inhibitors are a class of medications that work by blocking cortisol production in the body; typically these medicines are given one at a time. For a 53-year-old man with Cushing’s syndrome, however, two such therapies given together successfully reduced his cortisol levels and eased his symptoms, according to a case report. The man was initially treated with ketoconazole (sold under the name Nizoral, among others), and then switched to treatment with Isturisa (osilodrostat). But given alone, neither of these medicines adequately controlled his symptoms, and cortisol levels remained elevated. Researchers suggested that combining cortisol blockers may lead to better treatment management for some patients.

No. 2 – “Cushing’s Awareness Day on April 8 Spotlights Patient Journeys”

Cushing’s Awareness Day takes place every year on April 8th, the birthday of Harvey Cushing — the neurologist who first described the condition nearly a century ago. For the 2022 Cushing’s Awareness Day, companies and patient groups voiced their commitment to improving awareness about Cushing’s, and finding ways to better care for those living with the disease. Organizations also highlighted the journeys of individual patients diagnosed with Cushing’s.

No. 1 – “Low Vitamin D Levels in Patients Improved With Supplements”

Cortisol is known to indirectly regulate levels of vitamin D, a vitamin that’s important for bone health and immune function. Scientists assessed the levels of vitamin D in the blood of 50 Cushing’s patients, and found that, in more than half of them, levels were low enough to constitute a deficiency. Rates of vitamin D deficiency were markedly higher among patients than in a group of 48 people without Cushing’s. Researchers also found that vitamin D and cortisol levels were statistically correlated among the patients. Vitamin D levels in Cushing’s patients were increased when they were given supplements of this vitamin.

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We look forward to continuing to report on developments in the Cushing’s community in 2023, and we wish all our readers a happy new year!