Tumor removal surgery seen to benefit Cushing’s patients in study

Most see easing of hypertension, diabetes within 1 year of surgery

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by Andrea Lobo |

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While people with Cushing’s syndrome often experience hypertension, or high blood pressure, and diabetes — two conditions that put them at higher risk of developing cardiovascular diseases — tumor removal surgery was found to ease these conditions in a new study from Tunisia.

Indeed, most patients saw improvements within one year of undergoing surgery to remove disease-driving tumors that cause Cushing’s hallmark high cortisol levels, also referred to as hypercortisolism.

“Metabolic disorders were frequent during [Cushing’s syndrome] and their frequencies decreased after … remission from the syndrome,” which was achieved by many patients following surgery, the researchers wrote.

Still, the team noted that larger studies are needed to determine factors associated with the remission of these metabolic disorders in Cushing’s patients following curative surgery.

The study, “Metabolic disorders during endogenous Cushing’s syndrome: prevalence, associated factors, and outcome after remission,” was published in the journal Endocrine Regulations.

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Investigating the effects of tumor removal surgery in Cushing’s syndrome

Cushing’s syndrome encompasses diseases caused by an excess of the hormone cortisol, which is normally produced by the adrenal glands located atop the kidneys. The disease is considered endogenous when problems within the body itself cause cortisol levels to become excessively high.

Endogenous Cushing’s is commonly caused by tumors in the brain’s pituitary gland, which trigger the excessive production of another hormone called adrenocorticotropic hormone or ACTH. It’s ACTH that signals the adrenal glands to produce cortisol. This specific form of the syndrome is called Cushing’s disease.

Chronically high cortisol levels may cause several symptoms — including weight gain with a characteristic accumulation of fat in the torso, face, back of the neck, or between the shoulders.

The disease also can lead to a wide range of metabolic disorders, including hypertension, diabetes, and elevated levels of fatty molecules in the bloodstream, known as dyslipidemia.  These metabolic conditions are risk factors for cardiovascular diseases, which account for the increased mortality seen in people with Cushing’s.

However, “the prevalence of these disorders and the rates of remission after remission from [Cushing’s syndrome] vary widely between studies,” the researchers wrote.

Now, a team of scientists sought to determine the prevalence of metabolic disorders and risk factors in patients with endogenous Cushing’s syndrome. To that end, the team conducted a retrospective study in which they analyzed data from 75 patients who were followed at a hospital in Tunisia for more than 30 years, from 1987 to 2018.

These individuals had a mean age of 44.1 and more than 70% were women.

Nearly half of the patients (47%) had Cushing’s disease. About a third (35%) had benign tumors in one adrenal gland, while 5% had such tumors in both adrenal glands. In seven patients (9%), Cushing’s was being driven by high ACTH whose origin was unknown, and three patients (4%) had a rare type of malignant tumor, called a corticosurrenaloma, in the adrenal glands.

Weight gain was reported in 32 patients (43%), and estimated to be at a mean of 2.8 kg (around six pounds), according to data obtained from 14 patients.

The patients’ mean body mass index (BMI), a ratio of weight to height, was 31 kg/m2, a value that’s indicative of obesity. More than half of the patients (52%) were considered obese and a third (33%) were overweight.

Concerning metabolic diseases, 83% of the patients had dyslipidemia, 75% had hypertension, and 43% had diabetes.

The presence of these disorders in people with Cushing’s syndrome was not found to be related to age, gender, BMI, waist circumference, or cortisol levels at the study’s start.

However, metabolic syndrome, a cluster of conditions that increase the risk of cardiovascular diseases and was found in 73% of the patients in the study, was more frequent in those older than 30 than in those younger than 30 (84% vs. 44%).

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Overall, 48 patients underwent surgery, with 29 procedures involving the pituitary gland and 19 the adrenal glands. In 38 patients, Cushing’s syndrome went into remission by the end of the first year.

The frequency of hypertension decreased after the remission from [Cushing’s syndrome] and reached that of the general population (29% vs. 30%).

Researchers noted that the occurrence of hypertension and diabetes significantly decreased, by more than 50%, following Cushing’s remission.

“The frequency of hypertension decreased after the remission from [Cushing’s syndrome] and reached that of the general population (29% vs. 30%),” the team wrote, noting that frequency of diabetes following remission “was close to that of the general adult population (20% vs. 15%).”

Although the frequency of dyslipidemia decreased by 17% following remission, this reduction was not considered statistically significant, and the frequency of this condition remained higher in Cushing’s patients compared with the general population (69% vs. 21%).

According to the researchers, this result is consistent with other studies showing that “the effect of the treatment of hypercortisolism on dyslipidemia seems to be mild.”

In the future, “large prospective studies are needed to determine the factors associated with the metabolic disorders and more importantly the predictive factors of remission of the metabolic disorders after the cure of [Cushing’s syndrome],” the researchers concluded.