Even after successful treatment, patients with Cushing's disease who were older when diagnosed or had prolonged exposure to excess cortisol face a greater risk of dying or developing cardiovascular disease, according to a recent study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).
Cushing's disease is a rare condition where the body is exposed to excess cortisol -- a stress hormone produced in the adrenal gland -- for long periods of time.
Researchers have long known that patients who have Cushing's disease are at greater risk of developing and dying from cardiovascular disease than the average person. This study examined whether the risk could be eliminated or reduced when the disease is controlled. Researchers found that these risk factors remained long after patients were exposed to excess cortisol.
"The longer patients with Cushing's disease are exposed to excess cortisol and the older they are when diagnosed, the more likely they are to experience these challenges," said Eliza B. Geer, MD, of Mount Sinai Medical Center and lead author of the study. "The findings demonstrate just how critical it is for Cushing's disease to be diagnosed and treated quickly. Patients also need long-term follow-up care to help them achieve good outcomes."
The study found cured Cushing's disease patients who had depression when they started to experience symptoms of the disease had an elevated risk of mortality and cardiovascular disease. Men were more at risk than women, a trend that may be explained by a lack of follow-up care, according to the study. In addition, patients who had both Cushing's syndrome and diabetes were more likely to develop cardiovascular disease.
The study examined one of the largest cohorts of Cushing's disease patients operated on by a single surgeon. The researchers retrospectively reviewed charts for 346 Cushing's disease patients who were treated between 1980 and 2011. Researchers estimated the duration of exposure to excess cortisol by calculating how long symptoms lasted before the patient went into remission. The patients who were studied had an average exposure period of 40 months.
The findings may have implications for people who take steroid medications, Geer said. People treated with high doses of steroid medications such as prednisone, hydrocortisone or dexamethasone are exposed to high levels of cortisol and may experience similar conditions as Cushing's disease patients.
"While steroid medications are useful for treating patients with a variety of conditions, the data suggests health care providers need to be aware that older patients or those who take steroid medications for long periods could be facing higher risk," Geer said. "These patients should be monitored carefully while more study is done in this area."
Other researchers working on the study include: J. Lambert, J. Kostadinov, and K. Post of Mount Sinai Medical Center, and L. Goldberg and S. Fayngold of Mount Sinai School of Medicine.
- J. K. Lambert, L. Goldberg, S. Fayngold, J. Kostadinov, K. D. Post, E. B. Geer. Predictors of Mortality and Long-term Outcomes in Treated Cushing's Disease: A Study of 346 Patients. Journal of Clinical Endocrinology & Metabolism, 2013; DOI: 10.1210/jc.2012-2893
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