Predictors of Mortality, CVD Risk in Cushing's Disease ID'd

(HealthDay News) – A number of factors, including the duration of glucocorticoid exposure, older age at diagnosis, and preoperative adrenocorticotropic hormone (ACTH) concentration, are associated with a higher risk of mortality in patients treated for Cushing's disease (CD), according to research published online Feb. 7 in the Journal of Clinical Endocrinology & Metabolism.

In an effort to identify predictors of mortality, cardiovascular disease, and recurrence with long-term follow-up, Jessica K. Lambert, MD, of the Mount Sinai Medical Center in New York City, and colleagues performed a retrospective chart review of 346 patients with CD who underwent transsphenoidal adenectomy.

The researchers found that the average length of exposure to glucocorticoids was 40 months. The risk of death was higher for those patients who had a longer duration of glucocorticoid exposure, older age at diagnosis, and higher preoperative ACTH concentration. For patients who achieved remission, depressed patients had a higher risk of death. The risk of cardiovascular disease was highest for men, older people, and those with diabetes or depression.

"Our study has identified several predictors of mortality in patients with treated CD, including duration of exposure to excess glucocorticoids, preoperative ACTH concentration, and older age at diagnosis. Depression and male gender predicted mortality among patients who achieved remission," the authors write. "These data illustrate the importance of early recognition and treatment of CD. Long-term follow-up, with management of persistent comorbidities by an experienced endocrinologist, is needed even after successful treatment of CD."

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Early Detection, Treatment Needed To Reduce Risk Of Death, Cardiovascular Disease In Cushing's Disease Patients

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." 

From http://www.medicalnewstoday.com/releases/256284.php