The degree of urinary hypercortisolism is not correlated with the severity of cushing’s syndrome

Abstract

Cushing syndrome (CS) is characterized by increased morbidity and mortality compared to the general population. However, there are patients who have more clinical aggressive forms than others. Aim of the study is to evaluate whether the degree of hypercortisolism, defined by the number of times urinary free cortisol (UFC) levels exceed the upper limit of the normal range (ULN), is related to the worsening of phenotypic features, as well as metabolic and cardiovascular parameters, in a cohort of CS patients. A cross-sectional study was conducted on 192 patients with active CS, consecutively presenting at the outpatients' clinic of the University Hospitals of Ancona, Naples, and Palermo. Patients were grouped into mild (UFC not exceeding twice the ULN), moderate (2-5 times the ULN), and severe (more than 5 times the ULN) hypercortisolism. Thirty-seven patients (19.3 %) had mild, 115 (59.8 %) moderate, and 40 (20.9 %) severe hypercortisolism. A significant trend of increase among the three groups was demonstrated for 8-, 16-, and 24-h serum cortisol levels (p \ 0.001) and serum cortisol after low dose of dexamethasone suppression test (p = 0.001). No significant trend of increase was found regarding phenotype and comorbidities. The degree of hypercortisolism by itself does not appear to be a sufficient parameter to express the severity of CS. Therefore, estimating the severity of CS according to biochemical parameters remains a challenge, while the clinical phenotype and the associated comorbidities might be more useful to assessing the severity of the CS.

Factors predicting long-term comorbidities in patients with Cushing’s syndrome in remission

“…The severity of Cushing’s syndrome does not correlate with the extent of hypercortisolism [ 13 ]. Instead, diabetes and hypertension were found to be associated with older age and a longer exposure to excess glucocorticoids [ 7 , 8 ].…”

<p>Circulating Irisin Levels as a Marker of Osteosarcopenic-Obesity in Cushing’s Disease</p>

“…[14][15][16][17] Skeletal muscle is strongly influenced by glucocorticoid levels, resulting in muscle atrophy and weakness in patients with CD. Muscle weakness has been reported in 40-70% of patients with Cushing's syndrome (CS) [18][19][20] commonly affecting the proximal musculature of the lower limbs. Accordingly, patients typically complain about inability to get up from a squatting position or to climb stairs whereas running or walking is less frequently affected.…”

Insulin sensitivity and secretion and adipokine profile in patients with Cushing’s disease treated with pasireotide

“…CD is well known to be associated with obesity, insulin resistance and various degrees of carbohydrate intolerance, even though the pathogenesis of these disturbances seems not to be directly associated with hypercortisolism [14,15]. On the other hand, visceral adiposity has been shown to be a main determinant of insulin resistance and of cardiovascular risk in the general population [16][17][18].…”