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Cardiometabolic Outcomes after Surgical Remission of Endogenous Hypercortisolism: A Prospective Cohort Study
Shireen R Chacko1, Shubhangi Sharma Sharma1, Sarina Ahmadian1
1Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN 55905, USA.
Insights
Surgical remission of hypercortisolism improves cardiometabolic comorbidities like hypertension and diabetes in patients with Cushing syndrome (CS) and mild autonomous cortisol secretion (MACS). Higher baseline disease severity predicts greater post-surgical improvement.
Area of Science:
- Endocrinology
- Metabolic Medicine
- Surgical Outcomes
Background:
- Cardiometabolic comorbidities are common in hypercortisolism.
- Limited evidence exists on post-surgical outcomes for these conditions.
Purpose of the Study:
- To assess the impact of surgical remission on cardiometabolic comorbidities.
- To identify predictors of cardiometabolic improvement after surgery.
Main Methods:
- Prospective cohort study of adults with Cushing syndrome (CS) or mild autonomous cortisol secretion (MACS).
- Evaluated changes in hypertension, diabetes mellitus (DM), hyperlipidemia, and obesity at 3 and 12 months post-surgery.
- Multivariable analysis identified factors associated with comorbidity improvement.
Main Results:
- Significant improvement in hypertension, DM, and obesity observed post-surgery in both CS and MACS patients.
- Higher baseline biochemical severity scores correlated with greater improvement in hypertension, DM, and obesity.
- Improvement rates varied between CS and MACS groups for specific comorbidities.
Conclusions:
- Surgical remission of hypercortisolism leads to significant cardiometabolic improvements.
- Baseline disease severity is a key predictor of positive post-surgical outcomes.
- Further research can optimize management strategies for hypercortisolism patients.
Context:
Evidence on the evolution of cardiometabolic comorbidities following surgical remission of hypercortisolism is scarce.
Objective:
To determine the impact of surgical remission on cardiometabolic comorbidities in patients with endogenous hypercortisolism and to identify factors associated with cardiometabolic improvement.
Methods:
Prospective single-center cohort study (2019-2025) of adults with Cushing syndrome (CS) or mild autonomous cortisol secretion (MACS) with surgical remission of hypercortisolism. Outcomes included (1) changes in severity of hypertension, diabetes mellitus (DM), hyperlipidemia, and obesity between baseline, 3, and 12 months postremission and (2) factors associated with improvement in comorbidities.
Results:
Among 357 patients (49% MACS, 36% pituitary CS, 10% adrenal CS, 5% ectopic CS; median age 53 years [interquartile range 42-62]; 81% women), 336 (94%) had hypertension, 241 (68%) had obesity, and 122 (35%) had DM. At a median of 12 months postsurgery, improvement in hypertension occurred in 70% (90/128) of patients with CS and 51% (60/117) of patients with MACS, DM in 90% (46/51) patients with CS and 37% (13/35) patients with MACS, and obesity in 79% (77/97) patients with CS and 20% (14/71) patients with MACS. In a multivariable analysis, higher baseline biochemical severity scores were associated with improvement in hypertension [odds ratio (OR) 1.3, 95% confidence interval (CI) 1.1-1.5), DM (OR 2.5, 95% CI 1.7-4.1), and obesity (OR 1.5, 95% CI 1.2-1.8) at a median of 12 months postremission of hypercortisolism.
Conclusion:
Postsurgical improvement of cardiometabolic comorbidities was observed in both patients with CS and MACS. Higher baseline biochemical severity scores were associated with higher postremission improvement in comorbidities.
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