Metabolic Syndrome in Cushing's Syndrome Patients

Ferraú, Francesco; Korbonits, Márta

doi:10.1159/000486002

Cited by 42 publications

(31 citation statements)

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“…Moreover, in the group of patients with the development of autoimmune diseases after CS treatment, other than higher levels of endogen overproduction of cortisol, we have found higher levels of total cholesterol, LDL cholesterol, and triglycerides, confirming the unfavorable metabolic effects of hypercortisolism, especially on the lipid pattern [37]. It is well described in literature that CS patients have higher cardiovascular mortality and morbidity due to several metabolic alterations, regarding glucose and lipid metabolism, improved after CS treatment [38].…”

Section: Discussionmentioning

confidence: 71%

Autoimmune Diseases in Patients with Cushing’s Syndrome after Resolution of Hypercortisolism: Case Reports and Literature Review

Petramala

Olmati

Conforti

et al. 2018

International Journal of Endocrinology

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Introduction Cushing's syndrome (CS) is a clinical condition characterized by excessive cortisol production, associated with metabolic complications, such as diabetes mellitus, dyslipidemia, metabolic syndrome, hypertension, and cardiovascular diseases. Nowadays, the occurrence of autoimmune diseases in CS have not been completely evaluated in the previous studies. Objective The aim of this study was to evaluate the occurrence of autoimmune diseases in CS patients after successfully treated. Materials and Methods From January 2001 to December 2017, in our Secondary Hypertension Unit, we evaluated 147 CS patients (91 with ACTH-independent disease, 54 with ACTH-dependent disease, and 2 patients with ectopic ACTH production. Results 109 CS patients (74.1%) were surgically treated (67 ACTH-independent CS patients (61.5%) undergone adrenalectomy and 42 ACTH-dependent CS (38.5%) undergone transsphenoidal surgery) and evaluated after 6, 12, and 24 months after clinical and biochemical remission of disease. In 9 (8.3%) of overall treated CS patients (8.3%), during follow-up, we observed the onset of some manifestations of autoimmune diseases. In particular, one patient had a systemic lupus erythematosus, one patient had rheumatoid arthritis, 4 patients reported autoimmune thyroiditis (Basedow-Graves' disease and Hashimoto's thyroiditis), one patient had clinical features of psoriasis, one patient showed myasthenia gravis, and one patient had giant cell arteritis. Conclusions Our results demonstrate that patients successfully treated for CS could develop autoimmune diseases. Therefore, after treatment, CS patients need to be strictly monitored in order to evaluate the possible onset of autoimmune diseases.

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Section: Discussionmentioning

confidence: 71%

Autoimmune Diseases in Patients with Cushing’s Syndrome after Resolution of Hypercortisolism: Case Reports and Literature Review

Petramala

Olmati

Conforti

et al. 2018

International Journal of Endocrinology

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“…Severe acute respiratory syndrome due to coronavirus SARS-CoV2, or COVID- 19, has recently been identified to be a cause of severe pneumonia, with potential evolution to acute respiratory distress syndrome (ARDS), further complicated by cardiovascular and renal injury, particularly in older patients with metabolic comorbidities, such as obesity, hypertension and diabetes, in which higher morbidity and mortality have been observed [1,2]. Metabolic alterations are common clinical features of Cushing's syndrome (CS), a complex and challenging disease characterized by chronic glucocorticoid (GC) excess [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…Up to 100% of patients with CS show weight excess, mainly associated with visceral obesity. Indeed, GC excess results in increased abdominal visceral adipose tissue deposition and reduced peripheral subcutaneous adipose depots, probably due to the different GC responsiveness of visceral fat compared to subcutaneous fat [ 6 , 19 – 21 ]. Obesity represents an independent risk factor for development of severe COVID-19 infection, being associated with higher morbidity and mortality [ 2 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

Glucocorticoid excess and COVID-19 disease

Guarnotta

Ferrigno

Martino

et al. 2020

Rev Endocr Metab Disord

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The pandemic of coronavirus disease (COVID-19), a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is causing high and rapid morbidity and mortality. Immune system response plays a crucial role in controlling and resolving the viral infection. Exogenous or endogenous glucocorticoid excess is characterized by increased susceptibility to infections, due to impairment of the innate and adaptive immune system. In addition, diabetes, hypertension, obesity and thromboembolism are conditions overrepresented in patients with hypercortisolism. Thus patients with chronic glucocorticoid (GC) excess may be at high risk of developing COVID-19 infection with a severe clinical course. Care and control of all comorbidities should be one of the primary goals in patients with hypercortisolism requiring immediate and aggressive treatment. The European Society of Endocrinology (ESE), has recently commissioned an urgent clinical guidance document on management of Cushing’s syndrome in a COVID-19 period. In this review, we aim to discuss and expand some clinical points related to GC excess that may have an impact on COVID-19 infection, in terms of both contagion risk and clinical outcome. This document is addressed to all specialists who approach patients with endogenous or exogenous GC excess and COVID-19 infection.

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“…However, an excess of GCs has been implicated in the pathogenesis of metabolic disorders. Patients with Cushing syndrome, a condition characterized by elevated endogenous cortisol, usually exhibit hyperglycemia, insulin resistance, and liver steatosis (6)(7)(8). Furthermore, long-term use of GC synthetic analogs, such as dexamethasone (Dex) and hydrocortisone, has been linked to deleterious metabolic effects (9,10).…”

Section: Introductionmentioning

confidence: 99%