Erythropoiesis in Cushing syndrome: sex-related and subtype-specific differences. Results from a monocentric study
M Detomas1, T Deutschbein2,3, M Tamburello2,4
1Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany. detomas_m@ukw.de.
Insights
Cushing syndrome (CS) affects red blood cell (RBC) parameters differently in men and women. Women with CS have higher RBC levels, while men experience lower levels, suggesting anemia as a complication in males.
Area of Science:
- Endocrinology
- Hematology
- Internal Medicine
Background:
- Cushing syndrome (CS) is linked to various hematological abnormalities, but data on erythropoiesis remain conflicting.
- Existing research has not clearly defined sex- and subtype-specific alterations in red blood cell (RBC) parameters in CS patients.
Purpose of the Study:
- To investigate sex- and subtype-specific changes in RBC parameters in patients with CS.
- To compare RBC parameters at initial diagnosis and after remission in CS patients.
Main Methods:
- A retrospective, monocentric study involved 210 CS patients, with 162 women.
- Patients were matched 1:1 for sex and age with controls having pituitary microadenomas or adrenal incidentalomas.
- RBC parameters were analyzed at diagnosis and after remission.
Main Results:
- Women with CS exhibited higher hematocrit, hemoglobin, and mean corpuscular volume (MCV) than controls.
- Women with Cushing disease (CD) had higher RBC, hematocrit, and hemoglobin than those with ectopic Cushing (ECS).
- Men with CS showed lower hematocrit, RBC count, and hemoglobin, but higher MCV compared to controls. Hemoglobin decreased post-remission in both sexes.
Conclusions:
- CS presents with distinct sex- and subtype-specific RBC parameter alterations.
- Anemia should be considered a complication of CS in men, given their lower RBC parameters.
- RBC parameter differences in women may aid in distinguishing Cushing disease from ectopic Cushing syndrome.
Context:
Cushing syndrome (CS) is associated with different hematological abnormalities. Nevertheless, conflicting data about erythropoiesis in CS have been reported. Furthermore, it is unclear whether CS sex and subtype-specific alterations in red blood cells (RBC) parameters are present.
Objective:
To investigate sex and subtype-specific changes in RBC in patients with CS at initial diagnosis and after remission.
Design:
Retrospective, monocentric study including 210 patients with CS (women, n = 162) matched 1:1 for sex and age to patients with pituitary microadenomas or adrenal incidentalomas (both hormonally inactive). RBC parameters were evaluated at initial diagnosis and after remission.
Results:
Women with CS had higher hematocrit (median 42.2 vs 39.7%), hemoglobin (14.1 vs 13.4 g/dl) and mean corpuscular volume (MCV) (91.2 vs 87.9 fl) compared to the controls (all p < 0.0001). Women with Cushing disease (CD) showed higher hematocrit, RBC and hemoglobin levels than those with ectopic Cushing (ECS) (all p < 0.005). Men with CS had lower hematocrit (42.9 vs 44.7%), RBC count (4.8 vs 5.1n*106/µl) and hemoglobin (14.2 vs 15.4 g/dl), but higher MCV (90.8 vs 87.5 fl) than controls (all p < 0.05). In men with CS, no subtype-specific differences were identified. Three months after remission hemoglobin decreased in both sexes.
Conclusion:
CS is characterized by sexual and subtype-specific differences in RBC parameters. Compared to controls, women with CS showed higher hematocrit/hemoglobin levels, whereas men had lower hematocrit/hemoglobin, which further decreased directly after remission. Therefore, anemia should be considered as complication of CS in men. In women, differences in RBC parameters may help to differentiate CD from ECS.
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