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Clinical consequences of Cushing’s syndrome

Pituitary volume 15, pages 319–329 (2012)Cite this article

Abstract

Recent evidence suggests that correction of hypercortisolism in Cushing’s syndrome (CS) may not lead to complete remission of the clinical abnormalities associated with this condition. In particular, elevated cardiovascular risk may persist in “cured” CS patients long-term after eucortisolism has been reached. This is believed to be related with the maintenance of visceral obesity and altered adipokine secretory pattern which perpetuate features of metabolic syndrome, including impaired glucose tolerance, hypertension, dyslipidemia, atherosclerosis and hypercoagulability. Nephrolithiasis and incomplete recovery of bone mineral density have also been described in “cured” CS patients. Moreover, previous exposure to excess cortisol may have irreversible effects on the structures of the central nervous system controlling cognitive function and mood. Thus, sustained deterioration of the cardiovascular system, bone remodelling and cognitive function may be associated with high morbidity and poor quality of life in CS patients in remission for many years. Although mortality in “cured” CS patients may not differ from that in the general population, data beyond 20 years follow-up are very scarce, so further studies evaluating larger cohorts for longer follow-up periods are needed to draw definitive conclusions on longevity. Life-long monitoring is mandatory in CS patients in order to control long term complications of previous cortisol excess and, possibly, normalize life expectancy.

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Abbreviations

CS:

Cushing’s syndrome

CD:

Cushing’s disease

TNF-α:

Tumor necrosis factor-alpha

IL-6:

Interleukin-6

LV:

Left ventricular

VTE:

Venous thromboembolism

DXA:

Dual energy X-ray absorptiometry

BMD:

Bone mineral density

HPA:

Hypothalamic-pituitary-adrenal

HRQoL:

Health-related quality of life

GHD:

Growth hormone deficiency

SMR:

Standardized mortality ratio

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Affiliations

  1. Department of Medicine/Endocrinology, Research Group on Pituitary Diseases, Hospital Sant Pau, IIB-Sant Pau, Pare Claret 167, 08025, Barcelona, Spain

    Elena Valassi, Iris Crespo, Alicia Santos & Susan M. Webb

  2. Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Universitat Autónoma de Barcelona, Barcelona, Spain

    Elena Valassi, Iris Crespo, Alicia Santos & Susan M. Webb

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  1. Elena Valassi
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  2. Iris Crespo
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  3. Alicia Santos
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Correspondence to Elena Valassi.

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Valassi, E., Crespo, I., Santos, A. et al. Clinical consequences of Cushing’s syndrome. Pituitary 15, 319–329 (2012). https://doi.org/10.1007/s11102-012-0394-8

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Keywords

  • Cushing’s syndrome
  • Remission
  • Co-morbidities