Subtype-specific pattern of white blood cell differential in endogenous hypercortisolism.

Area of Science:

• Endocrinology and Immunology

Background:

• Endogenous hypercortisolism (Cushing's syndrome) is linked to immune dysfunction and increased infection risk.
• Specific patterns of white blood cell (WBC) and differential (WBCD) counts in relation to hypercortisolism subtypes are not well understood.

Purpose of the Study:

• To investigate subtype-specific patterns in WBC and WBCD counts in patients with endogenous hypercortisolism.
• To determine if WBCD can aid in differentiating between subtypes of Cushing's syndrome and autonomous cortisol secretion.

Main Methods:

• Retrospective monocentric cohort study of 253 patients with overt Cushing's syndrome (CS) or autonomous cortisol secretion (ACS).
• Analysis of WBC and WBCD counts at diagnosis and after biochemical remission.
• Receiver-operating characteristic (ROC) analysis to determine diagnostic cut-offs.

Main Results:

• Leukocytes and neutrophils positively correlated with cortisol levels, while lymphocytes and eosinophils showed negative correlations.
• Distinct neutrophil and lymphocyte counts differentiated Cushing's disease (CD) from ectopic CS (ECS) (neutrophil/lymphocyte ratio AUC 0.918).
• Platelet/lymphocyte ratio differentiated cortisol-producing adrenal adenomas (CPA) from adrenocortical carcinomas (ACC) (AUC 0.713).

Conclusions:

• Immune cell profiles correlate with hypercortisolism severity and vary significantly among CS subtypes.
• WBCD changes, including decreased neutrophils and increased lymphocytes, are evident as early as 3 months post-remission.