Intraocular pressure and its correlation with midnight plasma cortisol level in Cushing's disease and other endogenous Cushing's syndrome

Abstract

Purpose:The purpose of this study is to measure intraocular pressure (IOP) and evaluate the correlation between IOP and midnight plasma cortisol (MPC) level in patients with Cushing's disease (CD) and other endogenous Cushing's syndrome (ECS).Methods:This is a cross-sectional study from a single center including newly diagnosed patients with CD or ECS. All patients underwent detailed ophthalmological evaluation. IOP was measured by Goldmann applanation tonometry in the morning and evening on two consecutive days. MPC value was obtained for each patient. The data were compared using paired and unpaired t-test, Mann–Whitney U-test, and Spearman's rank correlation coefficient.Results:Among 32 patients, 22 were CD (68.75%) and 10 patients were other ECS (31.25%). A total of 25 patients (78.12%) in our study group had normal IOP (<22 mmHg), and seven patients (21.88%) had increased IOP (≥22 mmHg). The percentage of patients with normal IOP was found to be significantly higher compared to percentage of patients with high IOP (P = 0.001) using one-sample Chi-square test. Mean MPC value was 468.6 ± 388.3 nmol/L in patients having IOP ≥22 mmHg and 658.5 ± 584 nmol/L in those with IOP <22 mmHg from both CD and ECS groups, but the difference was not statistically significant. No correlation was found between IOP and MPC (Spearman's rank correlation rho = −0.16 [P = 0.38]).Conclusion:In CD and ECS patients, IOP elevation is an uncommon feature, and high IOP in either group does not correlate with MPC level.

Increased Risk of Ocular Hypertension in Patients with Cushing’s Disease: An Underestimated Comorbidity

“…The case had normalized IOP at one-year follow-up in a glaucoma clinic. Mishra et al reported that seven out of 22 patients had increased IOP in the CD cohort 11 . Though they found mean serum cortisol level was lower in patients with normal IOP comparing to those with high IOP, the difference was not statistically signi cant.…”

“…It was well known that systemic steroid was a signi cant risk factor for increased intraocular pressure (IOP) 5,6 , and the incidence may rise to 30-40% of the general population due to topical or systemic glucocorticoids usage 7,8 . However, only several case reports and two cohort studies [9][10][11] investigated the association between increased IOP and endogenous hypercortisolemia. The association between glaucoma and excessive endogenous cortisol, as well as the ophthalmological outcomes after endocrine remission due to a surgical resection were still unknown.…”

Increased Risk of Ocular Hypertension in Patients With Cushing’s Disease

“…The case had a normalized IOP at the 1-year follow-up in a glaucoma clinic. Mishra et al11 reported that 7 of 22 patients had increased IOP in a CD cohort. Although they found that the mean serum cortisol level was lower in patients with normal IOP compared with those with a high IOP, the difference was not statistically significant.…”

“…7,8 Several case reports have also investigated ocular hypertension in CD due to its high endogenous cortisol level. [9][10][11][12] However, the incidence of ocular hypertension in endogenous hypercortisolemia, as well as the IOP change after endocrine remission due to a surgical resection, remain unknown.…”

“…It is well known that the use of systemic steroids is a significant risk factor for increased intraocular pressure (IOP),5,6 and the incidence may rise to 30%–40% of the general population due to topical or systemic glucocorticoids usage 7,8. Several case reports have also investigated ocular hypertension in CD due to its high endogenous cortisol level 9–12. However, the incidence of ocular hypertension in endogenous hypercortisolemia, as well as the IOP change after endocrine remission due to a surgical resection, remain unknown.…”