Postoperative Changes in Cushing’s Syndrome
Corresponding Author: Sabaretnam Mayilvaganan, Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, Phone: +91 9655851510, e-mail: firstname.lastname@example.org
How to cite this article: Idrees S, Mayilvaganan S. Postoperative Changes in Cushing’s Syndrome. Indian J Endoc Surg Res 2023;18(1):39–40.
Source of support: Nil
Conflict of interest: Dr Sabaretnam Mayilvaganan is associated as the Associate Editorial Board member of this journal and this manuscript was subjected to this journal’s standard review procedures, with this peer review handled independently of this editorial board member and his research group.
Received on: 30 May 2023; Accepted on: 25 June 2023; Published on: 30 June 2023
Keywords: Endocrine, Endocrine surgery, Functional cyst.
Following is the postoperative picture of the child discussed in the article ‘Idrees S, Mayilvaganan S, Mandelia A. Organic hypercortisolism of childhood: Adrenal Cushing’s syndrome. 2022;17(2):78–79.1 We write this article to report the changes and outcomes that occur postoperatively in a patient with Cushing’s syndrome. It is a phenomenon every endocrine surgeon should appreciate and also the knife-happy endocrine surgeons should compare pre-Cushing photographs of the child or patient during surgery and postoperatively (Figs 1 and 2).
Systemic level of cortisol is the cause of symptoms and signs of Cushing’s syndrome; hence, one may expect that once the focus of the cortisol-secreting tumor is removed, the stigmata of hypercortisolism shall wane. However, available evidence-based literature suggests that the final outcomes of surgery for Cushing’s syndrome are associated with partial recovery and take a longer time than expected. Moreover, evaluating symptom resolution postoperatively is challenging, especially when the changes occur slowly over time.2
From India, Mishra et al.3 reported that in 37 patients with Cushing’s syndrome with a median follow-up of 5 years, symptoms persisted in about a third of patients, including diabetes in 29%, hypertension in 31%, proximal weakness in 44%, and obesity in 41%.
|HPA axis recovery||12–24 months|
Cognitive and psychological
Quality of life
|Growth rate improves but never reaches normal – compromised final height
Increased BMI, visceral obesity, impaired glucose metabolism, hyperlipidemia may persist
Hypertension improves but may not resolve completely
Bone density begins to improve 6 months after cure. Improves but never returns to normal—bone age perturbation
At risk of developing other autoimmune diseases
Cerebral atrophy, decline in IQ, cognitive decrement, memory and concentration impairment, personality change depression or anxiety, decline in school performance
Residual deficits in physical and/ or psychosocial scores
To conclude, while restoration to normal cortisol secretion by the various forms of treatment currently available is easy in Cushing’s syndrome, what is difficult is to attain a lasting clinical remission.
Sabaretnam Mayilvaganan https://orcid.org/0000-0002-2621-394X
5. Lindsay JR, Nansel T, Baid S, et al. Long-term impaired quality of life in Cushing’s syndrome despite initial improvement after surgical remission. J Clin Endocrinol Metab 2006;91(2):447–453. DOI: 10.1210/jc.2005-1058.
6. Broersen LHA, Andela CD, Dekkers OM, et al. Improvement but no normalization of quality of life and cognitive functioning after treatment of Cushing syndrome. J Clin Endocrinol Metab 2019;104(11):5325–5337. DOI: 10.1210/jc.2019-01054.
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