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

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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.

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Acknowledgments

We would like to thank the RIMEDRI project for supporting V. Guarnotta.

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Authors and Affiliations

  1. Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Sezione di Endocrinologia, Diabetologia e Malattie Metaboliche, Università degli Studi di Palermo, Palermo, Italy

    Valentina Guarnotta, Marco C. Amato, Alessandro Ciresi, Roberto Citarrella & Carla Giordano

  2. Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy

    Rosario Pivonello, Davide Iacuaniello, Chiara Simeoli & Annamaria Colao

  3. Clinica di Endocrinologia e del Metabolismo, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy

    Giorgio Arnaldi, Laura Trementino & Grazia Michetti

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  1. Valentina Guarnotta
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Guarnotta, V., Amato, M.C., Pivonello, R. et al. The degree of urinary hypercortisolism is not correlated with the severity of cushing’s syndrome. Endocrine 55, 564–572 (2017). https://doi.org/10.1007/s12020-016-0914-9

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