Complications of Cushing's disease - prospective evaluation and clinical characteristics. Do they affect the efficacy of surgical treatment?

ABSTRACT

INTRODUCTION: Hypercortisolaemia is the cornerstone of Cushing's disease (CD). It leads to the occurrence of typical somatic symptoms as well as cardiovascular and metabolic complications, which significantly increase morbidity and mortality and decrease quality of life in CD. MATERIAL AND METHODS: A prospective study included 36 patients with CD who were assessed in terms of duration of their disease symptoms as well as the incidence of arterial hypertension, glucose intolerance and diabetes, overweight, obesity and decreased bone mineral density (BMD). The relation was assessed between these particular complications and their impact on the efficacy of surgical treatment for CD. RESULTS: The prevalence in the study group of arterial hypertension was 79%, and diabetes was 16.7%, whereas the proportion of pre-diabetic states was 33%. 36.1% of patients fulfilled the criteria of obesity and an additional 44% were overweight. Decreased BMD was reported in 72.2% of patients. There was a confirmed relationship between the duration of CD symptoms and the occurrence of overt diabetes (p 〈 0.01) and any type of glucose homeostasis alterations (p = 0.04). In this studied group with CD, there was also an association demonstrated between the occurrence of arterial hypertension and overweight or obesity (p = 0.03). Simultaneously, there was no relationship between the duration of symptoms or the presence of particular organ complications and the efficacy of surgical treatment for CD. CONCLUSIONS: Longer duration of CD is associated with a higher risk of glucose intolerance and/or diabetes. The overweight/obesity presented in the majority of patients increases the risk of secondary hypertension in CD. However, the efficacy of transsphenoidal surgery does not depend directly on either disease duration or type of occurring complications.