Cushing's syndrome: Aftermath of the cure

Rosario Pivonello, Maria Cristina De Martino, Monica De Leo, Libuse Tauchmanovà, Antongiulio Faggiano, Gaetano Lombardi, Annamaria Colao

Research output: Contribution to journalArticlepeer-review

Abstract

Cushing's syndrome (CS) is a chronic and systemic disease caused by endogenous or exogenous hypercortisolism, associated with an increase of mortality rate due to the clinical consequences of glucocorticoid excess, especially cardiovascular diseases. After cure, usually obtained by the surgical removal of the tumor responsible for the disease, the normalization of cortisol secretion is not constantly followed by the recovery of the clinical complications developed during the active disease, and it is often followed by the development of novel clinical manifestations induced by the fall of cortisol levels. These evidences were mostly documented in patients with pituitary-dependent CS, after surgical resection of the pituitary tumor. Indeed, despite an improvement of the mortality rate, metabolic syndrome and the consequent cardiovascular risk have been found to partially persist after disease remission, strictly correlated to the insulin resistance. Skeletal diseases, mainly osteoporosis, improve after normalization of cortisol levels but require a long period of time or the use of specific treatment, mainly bisphosphonates, to reach the normalization of bone mass. A relevant improvement or resolution of mental disturbances has been described in patients cured from CS, although in several cases, cognitive decline persisted and psychological or psychiatric improvement was erratic, delayed, or incomplete. On the other hand, development or exacerbation of autoimmune disorders, mainly thyroid autoimmune diseases, was documented in predisposed patients with CS after disease remission. The totality of these complications persisting or occurring after successful treatment contribute to the impairment of quality of life registered in patients with CS after disease cure.

Original languageEnglish
Pages (from-to)1381-1391
Number of pages11
JournalArquivos Brasileiros de Endocrinologia e Metabologia
Volume51
Issue number8
Publication statusPublished - Nov 2007

Keywords

  • ACTH
  • Adrenal
  • Cardiovascular risk
  • Cortisol
  • Cure
  • Cushing's disease
  • Cushing's syndrome
  • Glucocorticoid excess
  • Hypercortisolism
  • Hypertension
  • Metabolic syndrome
  • Osteoporosis
  • Pituitary
  • Remission

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

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