Age and Hematologic Parameters Can Predict Prolonged Glucocorticoid Replacement After Remission Of Cushing Disease And Adrenal Cushing’s Syndrome

Posted on May 7, 2026 by MaryO

Abstract

Purpose

Duration of glucocorticoid (GC) replacement following curative treatment of endogenous Cushing’s syndrome (CS) is highly variable, with no validated markers to guide tapering or predict prolonged dependency. We evaluated clinical and hematologic predictors of GC duration, stratified by CS etiology and GC formulation.

Methods

This nationwide retrospective cohort included patients with endogenous CS diagnosed over 20 years (2000–2023) in the Clalit Health Services database from Israel. Patients with adrenal carcinoma or ectopic CS were excluded. Duration of GC therapy following curative pituitary or adrenal surgery was categorized as < 20 months or ≥ 20 months (median 19.3 months). Baseline hematologic indices including white blood cell count, neutrophil count, lymphocyte count, and neutrophil-to-lymphocyte ratio (NLR) were extracted/calculated from values recorded within 24 months prior to diagnosis.

Results

Among 103 patients (mean age 43.8 ± 13.7 years; 76.7% women), 41 had Cushing disease (CD) and 56 had adrenal CS. Fifty-one patients (49.5%) required ≥ 20 months of GC replacement. Patients requiring prolonged therapy were older (p = 0.0045) and had lower baseline neutrophils (p = 0.050) and NLR (p = 0.026), with significant hematologic differences seen in CD. Hydrocortisone use was associated with longer duration of GC replacement than prednisone. Overall survival did not differ by GC duration, but among CD patients, prolonged therapy was associated with lower survival (p = 0.045).

Conclusion

Older age, and lower baseline neutrophils and NLR, were associated with prolonged postoperative GC replacement. These findings suggest that routine hematologic markers may help predict delayed recovery and guide individualized tapering strategies.

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Detailed MRI Analysis Provides Correlations with Clinical Features and Response to Treatment in Cushing’s Disease

Posted on May 1, 2026 by MaryO

Detailed imaging analysis of patients with Cushing’s disease (CD) and other disorders caused by pituitary adenomas (tumors that arise from the pituitary, a small gland in the brain) provides correlation with clinical characteristics and treatment response, a new Turkish study reports.

The research, “Clinicopathological significance of baseline T2-weighted signal intensity in functional pituitary adenomas,” appeared in the journal Pituitary.

Diagnosis of pituitary adenomas is often done with magnetic resonance imaging (MRI), which provides data on the tumor’s localization, its invasiveness, as well as cell death and other changes. However, MRI does not enable precise evaluation of the tumor’s hormone production and behavior.

Studies on T2-weighted signal intensity (T2-WSI) — one of the basic parameters in MRI scans that highlights fat and water in the body — shows that it correlates with collagen content, degree of fibrosis (scarring), amyloid protein accumulation, and granulation pattern of somatotroph adenomas, which produce excessive levels of growth hormone, causing acromegaly (a hormonal disorder that results from too much growth hormone in the body).

Evaluation of granulation patterns is key in predicting response to somatostatin analogues (SSAs) treatment, the researchers observed. SSAs are intended to stop excess hormone production.

In contrast, analysis of T2-WSI in corticotroph adenomas — benign tumors typical in Cushing’s disease patients that release elevated levels of adrenocorticotropin (ACTH) – is still lacking.

The research team assessed the correlation of T2-WSI with clinical features, granulation patterns, and response to treatment in patients with functional pituitary adenomas (FPAs), which are collectively characterized by excessive production of one or more hormones.

Specifically, scientists focused on 29 patients with Cushing’s disease, 87 with acromegaly, and 78 with prolactinoma, a type of benign pituitary tumor that produces elevated amounts of prolactin.

Results showed that while most somatotroph adenomas (53%) were hypointense, which means a darker image on MRI, the majority of prolactinomas (55%) and corticotroph adenomas (45%) were at least generally hyperintense, meaning lighter on image.

Data also revealed that hyperintense somatotroph adenomas were larger, sparsely granulated, and exhibited reduced shrinkage after treatment with SSAs.

In contrast, hypointense tumors were associated with higher levels of baseline insulin-like growth factor (IGF)-1% ULN, a predictor of insulin sensitivity, and a better response to SSAs.

In women with prolactinomas, hyperintensity correlated with smaller tumor diameter. In turn, hypointense prolactinomas were linked with younger age at diagnosis, higher baseline prolactin levels, and resistance to treatment with a dopamine agonist.

Scientists also found that hyperintense corticotroph adenomas correlated with larger tumor size and a sparsely granulated pattern. No difference was found between hyper and hypointense adenomas on cortisol and ACTH levels.

Investigators also reported that T2-WSI was not correlated with better surgical outcomes or with recurrent Cushing’s disease. Analysis of tumor shrinkage in these patients was not possible, the researchers noted.

“Although in present there is no immediate clinical application, we believe that if medical shrinkage of corticotrophs ever became a part of clinical practice, similar analyses could be performed in the future,” the researchers wrote.

“Further studies with larger series are required in order to make stronger suggestions,” they added.

From https://cushingsdiseasenews.com/2018/03/23/detailed-mri-analysis-correlates-with-cushings-disease-clinical-features/

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Adrenocortical carcinoma masquerading as Cushing’s disease

Posted on May 1, 2026 by MaryO

BMJ Case Reports 2017; doi:10.1136/bcr-2016-217519

Summary

Cushing’s syndrome (CS) can be classified as adrenocorticotropic hormone (ACTH)-dependent or ACTH-independent depending on the ACTH levels.

However, 30% of the patients with CS have ACTH levels in the ‘grey zone’ (5–20 pg/mL), thereby posing a challenge in establishing the aetiological diagnosis. In a patient with full-blown features of Cushing’s syndrome with equivocal ACTH levels, and a pituitary microadenoma on contrast-enhanced MRI sella, can falsely lead to a diagnosis of Cushing’s disease. Pituitary microadenoma, if <6 mm in size, may be an incidental finding (incidentaloma) in this scenario and can be present in ∼3–27% of the healthy population. Therefore, in a patient with CS with equivocal ACTH levels and a pituitary microadenoma, multiple samplings for ACTH and adrenal imaging should be performed to exclude ACTH-independent CS and if required, bilateral inferior petrosal sinus sampling to determine the source of ACTH excess.

Find the entire article here: http://casereports.bmj.com/content/2017/bcr-2016-217519.full

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A Faster Way to Diagnose Cushing’s Syndrome

Posted on May 1, 2026 by MaryO

Diagnosing Cushing’s syndrome can take 24 hours of complicated and repeated analysis of blood and urine, brain imaging, and tissue samples from sinuses. But that may soon be in the past: National Institutes of Health (NIH) researchers have found that measuring cortisol levels in hair samples can do the same job faster.

Patients with Cushing’s syndrome have a high level of cortisol, perhaps from a tumor of the pituitary or adrenal glands, or as a side effect from medications. In the study, 36 participants—30 with Cushing’s syndrome, six without—provided hair samples divided into three equal segments. The researchers found that the segments closest to the scalp had the most cortisol (96.6 ± 267.7 pg/mg for Cushing’s syndrome patients versus 14.1 ± 9.2 pg/mg in control patients). Those segments’ cortisol content correlated most closely with the majority of the initial biochemical tests, including in blood taken at night (when cortisol levels normally drop).

The study was small; Cushing’s syndrome is rare, and it’s hard to recruit large numbers of patients. Still, the researchers believe it is the largest of its kind to compare hair cortisol levels to diagnostic tests in Cushing’s patients. “Our results are encouraging,” said Mihail Zilbermint, MD, the study’s senior author and an endocrinologist at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development. “We are hopeful that hair analysis may ultimately prove useful as a less-invasive screening test for Cushing’s syndrome or in helping to confirm the diagnosis.” The authors suggest the test is also a convenient alternative with the “unique ability” for retrospective evaluation of hypercortisolemia over months.

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From https://www.ptcommunity.com/journal/article/full/2017/4/271/research-briefs-april-2017

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Acute Pancreatitis Associated With Cushing Syndrome

Posted on April 30, 2026 by MaryO

Highlights

• There is a highs suspicion of acute pancreatitis complications for patients with Cushing syndrome.

• Corticosteroids are a common cause for both Cushing syndrome and acute pancreatitis.

• There are many common etiologies between Cushing syndrome and acute pancreatitis.

• Cushing syndrome is a risk factor of acute pancreatitis, need further detailed studies.

Abstract

Introduction

Cushing’s syndrome (CS) is a rare and severe disease. Acute pancreatitis is the leading cause of hospitalization. The association of the two disease is rare and uncommon. We report the case of a 37-year-old woman admitted in our service for acute pancreatitis and whose Cushing syndrome was diagnosed during hospiatilisation. The aim of this work is to try to understand the influence of de Cushing in acute pancreatitis and to establish a causative relationship between the two diseases.

Observation

It is a 37-year-old woman with a history of corticosteroid intake for six months, stopped three months ago who consulted for epigastralgia and vomiting. The physical exam found epigastric sensitivity with Cushing syndrome symptoms. A CT scan revealed acute edematous-interstitial pancreatitis stage E of Balthazar classification. 24 h free cortisol of 95 μg/24 h and cortisolemia of 3.4 μg/dl. The patient was treated symptomatically and referred after to endocrinology service for further treatment.

Conclusion

The association with acute pancreatitis and CS is rare and uncommon. Although detailed studies and evidence are lacking, it can therefore be inferred that CS is one of the risk factors for the onset of acute pancreatitis. The medical treatment and management of acute pancreatitis in those patients do not differ from other pancreatitis of any etiologies.

Read the article here.

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