, Volume 55, Issue 2, pp 564–572 | Cite as

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

  • Valentina Guarnotta
  • Marco C. Amato
  • Rosario Pivonello
  • Giorgio Arnaldi
  • Alessandro Ciresi
  • Laura Trementino
  • Roberto Citarrella
  • Davide Iacuaniello
  • Grazia Michetti
  • Chiara Simeoli
  • Annamaria Colao
  • Carla Giordano
Original Article


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.


Cushing syndrome severity Urinary free cortisol Cushing syndrome comorbidities Degree of hypercortisolism 


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Valentina Guarnotta
    • 1
  • Marco C. Amato
    • 1
  • Rosario Pivonello
    • 2
  • Giorgio Arnaldi
    • 3
  • Alessandro Ciresi
    • 1
  • Laura Trementino
    • 3
  • Roberto Citarrella
    • 1
  • Davide Iacuaniello
    • 2
  • Grazia Michetti
    • 3
  • Chiara Simeoli
    • 2
  • Annamaria Colao
    • 2
  • Carla Giordano
    • 1
  1. 1.Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Sezione di Endocrinologia, Diabetologia e Malattie MetabolicheUniversità degli Studi di PalermoPalermoItaly
  2. 2.Dipartimento di Medicina Clinica e Chirurgia, Sezione di EndocrinologiaUniversità Federico II di NapoliNaplesItaly
  3. 3.Clinica di Endocrinologia e del MetabolismoAzienda Ospedaliero-Universitaria Ospedali Riuniti di AnconaAnconaItaly

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