Cushing’s Syndrome Subtype Affects Postoperative Time to Adrenal Recovery

Posted on January 25, 2026 by MaryO

Berr CM. J Clin Endocrinol Metab. 2014;doi:10.1210/jc.2014-3632.

January 16, 2015

In patients undergoing curative surgical tumor resection for Cushing’s syndrome, the time to recovery of adrenal function is contingent upon the underlying etiology of the disease, according to recent findings.

In the retrospective study, researchers reviewed case records of 230 patients with Cushing’s syndrome. All patients were seen at a tertiary care center in Munich between 1983 and 2014, whose cases were documented in the German Cushing’s Registry. Patients were divided into three subgroups of Cushing’s syndrome: Cushing’s disease, adrenal Cushing’s syndrome and ectopic Cushing’s syndrome.

After applying various exclusion criteria, the researchers identified 91 patients of the three subgroups who were undergoing curative surgery at the hospital. The patients were followed for a median of 6 years. The researchers defined adrenal insufficiency as the need for hydrocortisone replacement therapy, and collected this information from patient records and laboratory results.

The duration of adrenal insufficiency was calculated as the interval between successful surgery and the completion of hydrocortisone replacement therapy. Cushing’s syndrome recurrence was defined as biochemical and clinical signs of hypercortisolism.

The researchers found a significant difference between Cushing’s syndrome subtypes in the likelihood of regaining adrenal function within 5 years of follow-up: The probability was 82% in ectopic Cushing’s syndrome, 58% in Cushing’s disease and 38% in adrenal Cushing’s syndrome (P=.001). Among the 52 participants who recovered adrenal function, the median type to recovery also differed between subtypes and was 0.6 years in ectopic Cushing’s syndrome, 1.4 years in Cushing’s disease and 2.5 years in adrenal Cushing’s syndrome (P=.002).

An association also was found between younger age and adrenal recovery in the Cushing’s disease participants (P=.012).

This association was independent of sex, BMI, symptom duration, basal adrenocorticotropic hormone and cortisol levels. No association was seen between adrenal recovery and length of hypercortisolism or postoperative glucocorticoid replacement dosage.

“It is the main finding of this series that the median duration of tertiary adrenal insufficiency was dependent on the etiology of [Cushing’s syndrome]: It was shortest in the ectopic [Cushing’s syndrome], intermediate in [Cushing’s disease] and longest in adrenal [Cushing’s syndrome] caused by unilateral cortisol producing adenoma,” the researchers wrote. “The significant difference to [Cushing’s disease] is an unexpected finding since by biochemical means cortisol excess is generally less severe in adrenal [Cushing’s syndrome]. If confirmed by others, our data have clinical impact for the follow-up of patients after curative surgery: Patients should be informed that adrenocortical function may remain impaired in benign conditions such as cortisol-producing adenoma.”

Disclosure: The study was funded in part by the Else Kröner-Fresenius Stiftung.

The original article is here: Healio

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Some Lifestyle Tips for Cushing’s Syndrome

Posted on January 22, 2026 by MaryO

There are some ideas in the post below and some at http://www.cushings-info.com/index.php?title=Help_Yourself,_Part_1 (and also parts 2 and 3!)

Do you have any other helpful tips for the New Year?

Below is from https://www.endocrineweb.com/conditions/cushings-syndrome/4-lifestyle-tips-cushings-syndrome

As part of your overall Cushing’s syndrome treatment plan, there are some lifestyle tips you can incorporate to help you live well with Cushing’s syndrome.

Below are 4 lifestyle tips you can integrate into your recovery plan from Cushing’s syndrome. Have a conversation with your doctor before making any major changes, such as starting to exercise regularly.

  1. Eat smart. Make sure you’re eating nutritious foods. Of course, you should focus on eating fruits and vegetables, which are high in anti-oxidants, but also eat whole grains, lean protein, and healthy fats. These foods fuel your body by giving you healthy doses of energy.

    Also, be sure you get enough calcium and vitamin D in your diet. These nutrients help strengthen bones (important because bone loss is common with people who have Cushing’s syndrome). If you don’t get enough of these in your diet, talk to your doctor about taking calcium and vitamin D supplements.

    A registered dietitian (RD) can help you create a balanced meal plan—the key word here is “balanced.” Yes, you can still eat the foods you love (in moderation), but it’s important to eat foods that boost your health. An RD can also help you lose extra weight you gained from Cushing’s syndrome.

  2. Exercise gently. Exercise plays a significant role in any healthy lifestyle, but it’s important for you not to rush into it. Even if you think you’re feeling better, your body still needs time to heal.

    Start off slowly-you may want to try low—impact exercise, such as water aerobics, tai chi, or yoga. These exercises gently re-build your muscles and joints. From there, you can work up to a more moderate-paced exercise routine. You can also work with a personal trainer who can customize a workout plan for you.

    Exercising should be comfortable. If you experience pain or any new symptoms when exercising, talk to your doctor right away.

  3. Keep tabs on your mental health. Your mental health can take a toll when you have Cushing’s syndrome—depression is common. If you feel blue or you don’t feel like doing the things you used to and you’re not sure why, don’t ignore it. Talk to your doctor—he or she can recommend a psychologist who can help you cope with your feelings throughout your recovery.

    You may also want to keep a journal to record how you feel on a day-to-day basis.

  4. Give yourself a break. Don’t be hard on yourself as your body recovers from Cushing’s syndrome. It’s important to get plenty of rest, relaxation, and sleep. Treat yourself to a gentle massage, warm bubble bath, or listen to soothing music. Now’s not the time to push yourself—respect your body and its limits.

Incorporating these lifestyle tips into your routine can not only help you live well, but they can help you thrive with Cushing’s syndrome.

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Topical Ocular Glucocorticoid Leads to Cushing’s Syndrome in 9-Year-Old

Posted on January 21, 2026 by MaryO

Some content on this page was disabled on January 28, 2026 as a result of a DMCA takedown notice from Haymarket Media, Inc. You can learn more about the DMCA here:

https://wordpress.com/support/copyright-and-the-dmca/

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Cushing’s Syndrome Etiology Affects Adrenal Function Recovery

Posted on January 21, 2026 by MaryO
Abstract
Context:
Successful tumor resection in endogenous Cushing’s syndrome (CS) results in tertiary adrenal insufficiency requiring hydrocortisone replacement therapy.
Objective:

The aim was to analyze the postsurgical duration of adrenal insufficiency of patients with Cushing’s disease (CD), adrenal CS and ectopic CS.

Design:

We performed a retrospective analysis based on the case records of 230 CS patients in our tertiary referral center treated from 1983 to 2014. The mean follow-up time was 8 years.

Patients:
We included 91 patients of the three subtypes of CS undergoing curative intended surgery and documented follow-up after excluding cases with persistent disease, pituitary radiation, concurrent adrenostatic or somatostatin analogue treatment, and malignant adrenal disease.
Results:

The probability of recovering adrenal function within a 5 years follow-up differed significantly between subtypes (p=0.001). It was 82 % in ectopic CS, 58 % in Cushing’s disease and 38 % in adrenal CS. In the total cohort with restored adrenal function (n=52) the median time to recovery differed between subtypes: 0.6 (IQR 0.03–1.1) years in ectopic CS, 1.4 (IQR 0.9–3.4) years in CD, and 2.5 (IQR 1.6–5.4) years in adrenal CS (p=0.002). In CD the Cox proportional-hazards model showed that the probability of recovery was associated with younger age (hazard ratio 0.896, 95% CI 0.822–0.976, p=0.012), independently of sex, BMI, duration of symptoms, and basal ACTH and cortisol levels. There was no correlation with length and extend of hypercortisolism or postoperative glucocorticoid replacement doses.

Conclusions:

Time to recovery of adrenal function is dependent on the underlying etiology of CS.

Affiliations
  • 1Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, Germany;
  • 2Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Germany;
  • 3Chirurgische Klinik und Poliklinik – Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, Germany;
  • 4Klinik für Neurochirurgie, Klinikum Grosshadern, Ludwig-Maximilians-Universität München, Germany;
  • 5IMSE, Klinikum rechts der Isar der TU München, München, Germany

From http://press.endocrine.org/doi/abs/10.1210/jc.2014-3632

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CV risk elevated in patients with adrenal incidentalomas, mild hypercortisolism

Posted on January 17, 2026 by MaryO

Patients with adrenal incidentalomas and mild hypercortisolism have an increased risk for cardiovascular events and mortality. This risk was evident even when clinical signs of overt hypercortisolism were not present, according to data published in The Lancet Diabetes & Endocrinology.

“Our findings are important because they add to the previously scant information about adrenal incidentalomas, which will be of use to doctors who are seeing an increasing number of patients with these masses,” Renato Pasquali, MD, of the S. Orsola-Malpighi Hospital in Bologna, Italy, said in a press release.

The retrospective study by Pasquali and colleagues assessed the adrenal incidentalomas of 198 outpatients treated every 18 to 30 months, with a mean follow-up of 7.5 years. At the time of follow-up, 114 patients demonstrated stable non-secreting adrenal incidentalomas (<50 nmol/L), 61 had either a stable intermediate phenotype (50 nmol/L-138 nmol/L) or subclinical Cushing’s syndrome (>138 nmol/L), and 23 patients had worsening pattern of secretion.

The incidence of CV events appeared higher in patients with a stable intermediate phenotype or subclinical Cushing’s syndrome (6.7% vs. 16.7%; P=.04) and in those with worsened secreting patterns (6.7% vs. 28.4%; P=.02) compared with patients with stable non-secreting adrenal incidentalomas, according to data.

In addition, CV events were independently related to changes in cortisol concentrations after the 1-mg dexamethasone suppression test (DST; HR=1.13; 95% CI, 1.05-1.21) from baseline to follow-up.

Patients with stable intermediate phenotype adrenal incidentalomas (57%) or subclinical Cushing’s syndrome (91.2%) tended to have lower survival rates for all-cause mortality (P=.005), researchers wrote. The main risk factors for all-cause mortality were age (HR=1.06; 95% CI, 1.01-1.12) and mean concentrations of cortisol after DST (HR=1.1; 95% CI, 1.01-1.19).

The unadjusted survival for CV-related mortality was lower in patients with either a stable intermediate phenotype (97.5%) or subclinical Cushing’s syndrome (78.4%; P=.02) vs. those with stable non-secreting adrenal incidentalomas (97.5%), and patients with worsened secreting patterns (60%; P=.01).

In an accompanying comment, Rosario Pivonello, MD, PhD, Maria Cristina De Martino, PhD, and Annamaria Colao, MD, PhD, of the Federico II University of Naples, Italy, wrote that the study supports the importance of long-term hormonal follow-up for clinical management of patients with adrenal incidentalomas.

“Furthermore, clinical monitoring of cardiometabolic risks seems to be important in these patients, particularly in those with subclinical Cushing’s syndrome and intermediate phenotype adrenal incidentalomas, for whom medical or surgical intervention could be needed,” they wrote.

They suggest long-term prospective studies to determine the frequency of new CV events and mortality in this patient population.

For more information:

Di Dalmazi G. Lancet Diabetes Endocrinol. 2014;doi:10.1016/S2213-8587(13)70211-0.

Pivonello R. Lancet Diabetes Endocrinol. 2014;doi:10.1016/S2213-8587(13)70190-6.

Disclosure: The researchers report no relevant financial disclosures.

This article is from http://www.healio.com/endocrinology/adrenal/news/online/%7B85f94352-9529-4cb7-9532-9c4518f77d80%7D/cv-risk-elevated-in-patients-with-adrenal-incidentalomas-mild-hypercortisolism

 

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