Improved cardiometabolic outcomes seen after surgical remission of endogenous hypercortisolism

Cardiometabolic comorbidities have shown improvements following surgery in patients with Cushing syndrome (CS) and those with mild autonomous cortisol secretion (MACS), reports a study.

“Higher baseline biochemical severity scores were associated with higher postremission improvement in comorbidities,” the investigators said.

This prospective single-centre cohort study included 357 adults (median age 53 years) with CS or MACS with surgical remission of hypercortisolism: 49 percent MACS, 36 percent pituitary CS, 10 percent adrenal CS, 5 percent ectopic CS.

The investigators assessed outcomes such as changes in hypertension severity, diabetes mellitus (DM), hyperlipidemia, and obesity between baseline, 3, and 12 months postremission, as well as factors associated with improvement in comorbidities.

Of the patients, 336 (94 percent) had hypertension, 241 (68 percent) had obesity, and 122 (35 percent) had DM.

At a median of 12 months after surgery, 70 percent (90/128) of patients with CS and 51 percent (60/117) of those with MACS showed improvements in hypertension, while 90 percent (46/51) and 37 percent (13/35) had improvements in DM, respectively. Obesity also improved in 79 percent (77/97) of patients with CS and 20 percent (14/71) of those with MACS.

Multivariate analysis revealed that higher baseline biochemical severity scores predicted improvements in hypertension (odds ratio [OR], 1.3, 95 percent confidence interval [CI], 1.1‒1.5), DM (OR, 2.5, 95 percent CI, 1.7‒4.1), and obesity (OR, 1.5, 95 percent CI, 1.2‒1.8) at a median of 12 months postremission of hypercortisolism.