Gender-dependent changes in haematological parameters in patients with Cushing's disease before and after remission

Abstract

Objective: Glucocorticoids stimulate several steps in red blood cell (RBC) development; however, little is known on changes in erythroid parameters in patients with Cushing's disease. The aim of this study was to assess both RBC and white blood cell (WBC) parameters in a large cohort of patients with Cushing's disease and report on alterations in the active phase and after surgical remission. Design and methods: A total of 80 patients with Cushing's disease (63 women and 17 men) were studied before and for up to 254 months' follow-up (mean follow-up 65.8G6.71 months) after pituitary/adrenal surgery. Details of blood counts were reviewed and compared with data obtained from a database of healthy subjects. Results: The RBC counts and haemoglobin levels were low in men with active Cushing's disease (over 80% of values in the lowest quartile) and four patients were overtly anaemic, whereas erythrocyte counts and haemoglobin levels were evenly distributed across the normal range in women with active Cushing's disease. Low erythroid parameters were linked to hypogonadism in men with Cushing's disease. Recovery in erythroid parameters occurred slowly after remission of hypercortisolism in men, in parallel with improvements in testosterone levels. Over 50% of patients with active disease presented increased WBC counts, irrespective of gender, and prompt normalisation within 1 month after surgery. Conclusions: Male patients with Cushing's disease present reduced RBC counts and haemoglobin levels, associated with low testosterone concentrations, which resolve over time after remission of hypercortisolism. Anaemia should therefore be regarded as another unfavourable feature in men with Cushing's disease.

Gender-Specific Differences in Clinical Profile and Biochemical Parameters in Patients with Cushing’s Disease: A Single Center Experience

“…Results of the present study have indicated that the hemoglobin concentration is greater in men than in women. This is contrary to previous reports showing that men with CD have low-to-normal hemoglobin concentration [ 9 ]. This difference greatly depends on the testosterone levels.…”

“…Several studies have demonstrated that testosterone has effects on erythropoiesis [ 18 , 19 ]. In the present study, testosterone concentrations were within a normal range, whereas hypogonadism was diagnosed in all but three male patients in the study of Ambrogio et al [ 9 ].…”

“…Furthermore, male patients presented with more severe complications than women, including hypokalaemia, hypercoagulable state and osteoporosis at the lumbar spine, vertebral fractures, and dyslipidemia. Other investigators also found differences in hematological parameters between males and females with CD [ 9 ].…”

Sexual Dimorphism in Cellular and Molecular Features in Human ACTH-Secreting Pituitary Adenomas

“…In fact, our first report on gender-dependent differences among these patients [3] was subsequently confirmed by other investigators [6][7][8][9]. Male patients with Cushing's disease usually present at a younger age, with more severe hypercortisolism and pronounced clinical features; hypogonadism induced by cortisol excess appears an important contributor to some clinical signs in males [8,39,40]. As regards hormonal secretion, urinary free cortisol levels are higher in male patients with Cushing's disease [3,6] as occurs in normal adult men [41,42]; plasma ACTH concentrations follow the same pattern as higher levels have been observed in male patients [3,6,7,9], as well as in normal men [42,43].…”

The Eosinophil Count Tends to Be Negatively Associated with Levels of Serum Glucose in Patients with Adrenal Cushing Syndrome

“…Moreover, T helper type 2 (Th2) cytokines secreted by eosinophils inhibit the inflammatory response by modulating macrophage polarization in adipose tissue, leading to an amelioration of glucose intolerance in mice [ 9 ]. The eosinophil count in peripheral blood is lower in patients with Cushing syndrome compared to healthy subjects [ 11 12 ]. However, it remains to be determined whether characteristics of the eosinophil population are correlated with the level of serum glucose in patients with Cushing syndrome.…”