Post-cushing’s Syndrome Events: Remission is not Always the End of the Story

Background:
While successful surgery for Cushing`s syndrome (CS) may lead to dramatic clinical improvement, associated morbidities may persist and adverse treatment effects may occur in remission.

Objective:
Describe the metabolic features and adverse treatment outcomes in patients with CS who achieved remission.

Methods:
Retrospective electronic charts-review of patients, insured at Maccabi Healthcare Services, who underwent successful surgery for non-malignant CS in 2005-2019 without evidence of recurrence.

Results:
The cohort included 100 patients (80 women, age 44.9±14); 55% with pituitary and 45% with adrenal CS. Mean weight reduction was 10.1±8.8kg following surgery, from 83.4±21.5kg at diagnosis (BMI 30.2±7.3kg/m2) to 72.5±20kg at 14.5±17.2 months post-surgery (BMI 26.4±6.2kg/m2) (p<0.001).

Rates of hypertension and diabetes mellitus/impaired fasting glucose decreased from 54% and 40% at diagnosis, to 26% and 21% during remission, respectively (p<0.001).

Surgical complications included prolonged/permanent diabetes insipidus in 6 patients and one case of panhypopituitarism.

Glucocorticoid-replacement therapy was administered to 96/100 patients for 25.1±43.4 months. Nine patients were admitted to emergency-room due to hypoadrenalism. Glucocorticoid-withdrawal symptoms, including poly-arthralgia, skin-rash and severe weakness, were recorded in 22/96 patients (22.9%).

Within the first post-surgical year, 9/100 patients experienced new/relapse of immune/allergic/steroid-responsive conditions, mainly arthritis and asthma/atopic-dermatitis. Three women were newly diagnosed with depression and 2 had exacerbation of depression. Psychosis was newly diagnosed in 2 women and fibromyalgia in 3 women.

Conclusions:
Significant weight-loss and metabolic improvement occur in remission of non-malignant CS. Yet, increased awareness to the risk of adverse "post-CS" outcomes in a significant percentage of patients may impact treatment decisions