Surgical remission of Cushing's syndrome reduces cardiovascular risk

• Published in: European journal of endocrinology Vol. 171; no. 1; pp. 127 - 136
• Main Authors: Terzolo, M, Allasino, B, Pia, A, Peraga, G, Daffara, F, Laino, F, Ardito, A, Termine, A, Paccotti, P, Berchialla, P, Migliaretti, G, Reimondo, G
• Format: Journal Article
• Language: English
• Published: Bristol Bioscientifica Ltd 01-07-2014; BioScientifica
• Subjects: Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Adult; Aged; Biological and medical sciences; Cardiovascular Diseases - pathology; Clinical Study; Cushing Syndrome - pathology; Cushing Syndrome - surgery; Endocrinopathies; Female; Fundamental and applied biological sciences. Psychology; Humans; Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Retrospective Studies; Vertebrates: endocrinology; Endocrinopathy; Treatment; Adrenal cortex diseases; Surgery; Adrenal gland diseases; Risk factor; Cardiovascular risk; Cushing syndrome; Cardiovascular disease; Remission; Hyperadrenocorticism; Endocrinology
• ISSN: 0804-4643; 1479-683X
• DOI: 10.1530/EJE-13-0555

ObjectiveRecent studies have questioned the reversibility of complications of Cushing's syndrome (CS) after successful surgical treatment. The aim of this study was to assess the outcome of patients with CS who achieved disease remission compared with those patients with persistent hypercortisolism and matched controls.DesignA retrospective study of 75 patients with CS followed at an academic center.MethodsCardiovascular risk profile was evaluated in 51 patients with CS in remission (group 1) and 24 patients with persistent disease (group 2) and compared with 60 controls. Mortality of patients with CS was compared with the background population.ResultsIn group 1, the frequency of cardiovascular risk factors dropped after disease remission even if it remained higher at the last follow-up than in the control group. In group 2, the frequency of cardiovascular risk factors remained unchanged during follow-up. The rate of cardiovascular and thromboembolic events was higher in group 2 than in group 1, as was the mortality rate (two deaths in group 1 and nine in group 2; ratio of two SMRs, 0.11; 95% CI, 0.011–0.512). Survival was significantly longer in group 1 than in group 2 (87 months, 80–98 vs 48 months, 38–62; P<0.0001).ConclusionsSuccessful surgical treatment of hypercortisolism significantly improves cardiovascular risk and may reduce the mortality rate. Patients with persistent disease have increased morbidity and mortality when compared with patients in remission.