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Cited by 60Pituitary Gland Disorders and TreatmentsAdrenal and Paraganglionic TumorsAdrenal Hormones and Disorders

Factors predicting long-term comorbidities in patients with Cushing's syndrome in remission

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Schernthaner-Reiter, Marie Helene, Siess, Christina, Gessl, Alois, Scheuba, Christian, Wolfsberger, Stefan, Riss, Philipp, Knosp, Engelbert, Luger, Anton +1 more·2019·Endocrine
DOI 10.1007/s12020-018-1819-6PMC PMC6453862
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Abstract

PURPOSE: In Cushing's syndrome, comorbidities often persist after remission of glucocorticoid excess. Here, we aim to identify factors predicting long-term comorbidities in patients with Cushing's syndrome in remission. METHODS: In a retrospective cross-sectional study, 118 patients with Cushing's syndrome in remission (52 pituitary, 58 adrenal, 8 ectopic) were followed for a median of 7.9 years (range 2-38) after the last surgery. Associations between baseline anthropometric, metabolic, hormonal parameters at diagnosis, and comorbidities (obesity, diabetes, hyperlipidemia, hypertension, osteoporosis, depression) at last follow-up, were tested by uni- and multivariate regression analysis. RESULTS: In patients with manifest comorbidities at diagnosis, remission of Cushing's syndrome resolved diabetes in 56% of cases, hypertension in 36% of cases, hyperlipidaemia in 23%, and depression in 52% of cases. In a multivariate regression analysis, age, fasting glucose, BMI, and the number of comorbidities at diagnosis were positive predictors of the number of long-term comorbidities, while baseline 24-h urinary free cortisol (UFC) negatively correlated with the persistence of long-term comorbidities. The negative relationship between baseline UFC and long-term comorbidities was also found when pituitary and adrenal Cushing's cases were analyzed separately. Baseline UFC was negatively related to the time of exposure to excess glucocorticoids. CONCLUSIONS: Long-term comorbidities after remission of Cushing's syndrome depend not only on the presence of classic cardiovascular risk factors (age, hyperglycemia, BMI), but also on the extent of glucocorticoid excess. Lower baseline UFC is associated with a higher number of long-term comorbidities, possibly due to the longer exposure to excess glucocorticoids in milder Cushing's syndrome.

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  • Among patients with CS, normalization of cortisol concentrations results in improvements in morbidity, mortality, and quality of life.

    “Among patients with CS, normalization of cortisol concentrations results in improvements in morbidity, mortality, and quality of life (28, 35, 109, 110).”

    From Measuring cortisol in Cushing syndrome: diagnosis, monitoring, and cortisol circadian rhythm improvement. (2026) · cites this paper as [35]

    The Introduction (page unavailable) says remission of glucocorticoid excess often improves signs and symptoms, but comorbidities are not always reversible. The Discussion (page unavailable) notes residual impairment in quality of life, while the Introduction says cardiovascular mortality risk remains elevated decades after remission. The paper therefore does not support an unqualified claim of improvements in all three outcomes, particularly mortality. (LLM, conf=0.88)

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  • Lower baseline UFC values at the time of CS diagnosis have been associated with a higher number of long-term comorbidities, compared to patients with high UFC values at diagnosis.

    “Additionally, lower baseline UFC values at the time of CS diagnosis have been associated with a higher number of long-term comorbidities, compared to patients with high UFC values at diagnosis (35).”

    From Measuring cortisol in Cushing syndrome: diagnosis, monitoring, and cortisol circadian rhythm improvement. (2026) · cites this paper as [35]

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Authors
Schernthaner-Reiter, M. H., Siess, C., Gessl, A., Scheuba, C., Wolfsberger, S., Riss, P., Knosp, E., Luger, A., & Vila, G.
Affiliations
Medical University of Vienna (AT)
Corresponding author
Vila, Greisa
ORCID
Venue
Endocrine
Publisher
Springer Science and Business Media LLC
Published
2018-11-22
Volume
64
Issue
1
Pages
157-168
ISSN
  • 0969-711X (ISSN-L)
  • 1355-008X
  • 1559-0100
DOI
10.1007/s12020-018-1819-6
PMC
PMC6453862
OpenAlex
W2901051559
Cited by
60
References
10
Citations by year
2026: 10 · 2025: 9 · 2024: 6 · 2023: 13 · 2022: 9 · 2021: 9 · 2020: 3 · 2019: 1
FWCI
2.59
Type
journal article
Language
en
Update notices
correction (2019-01-24)
Open access
Licence
Locations
  • Endocrine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
Medizinische Universität Wien
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords
Cushing's syndrome, remission, 24-hour urinary free cortisol, glucocorticoid excess, pituitary Cushing's disease, adrenal Cushing's syndrome, ectopic ACTH syndrome, diabetes mellitus, hypertension, hyperlipidemia, obesity, osteoporosis, depression, cardiovascular risk factors
MeSH terms
Adult, Cross-Sectional Studies, Cushing Syndrome, Diabetes Mellitus, Type 2, Female, Humans, Hyperlipidemias, Hypertension, Male, Middle Aged, Osteoporosis, Retrospective Studies, Risk Factors, Metabolic Syndrome, Overweight

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