Postoperative Changes in Cushing’s Syndrome

Sarah Idrees¹, Sabaretnam Mayilvaganan²https://orcid.org/0000-0002-2621-394X

^1,2Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Corresponding Author: Sabaretnam Mayilvaganan, Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, Phone: +91 9655851510, e-mail: drretnam@gmail.com

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).

Fig. 1: Postoperative photograph of child operated for organic hypercortisolism due to adrenal tumor

Fig. 2: Preoperative photograph of child with Cushing’s syndrome due to organic hypercortisolism due to adrenal tumor

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

Sippel et al.² provided a timeline of symptom resolution in a study (Fig. 3).

Fig. 3: Mean time to resolution of symptoms in an operated patient of Cushing’s syndrome (adapted from RS Sippel et al.)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

Growth
Metabolic
Cardiovascular
Bone
Other
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

The following list gives an insight into the changes that occur postoperatively in patients with Cushing’s syndrome:^4–6

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.

ORCID

Sabaretnam Mayilvaganan https://orcid.org/0000-0002-2621-394X

REFERENCES

1. Idrees S, Mayilvaganan S, Mandelia A. Organic Hypercortisolism of Childhood: Adrenal Cushing’s Syndrome. 2022; 17(2):78–79.DOI: 10.5005/jp-journals-10088-11200.

2. Sippel RS, Elaraj DM, Kebebew E, et al. Waiting for change: Symptom resolution after adrenalectomy for Cushing’s syndrome. Surgery 2008;144(6):1054–1060. DOI: 10.1016/j.surg.2008.08.024.

3. Mishra AK, Agarwal A, Gupta S, et al. Outcome of adrenalectomy for Cushing’s syndrome: Experience from a tertiary care center. World J Surg 2007;31(7):1425–1432. DOI: 10.1007/s00268-007-9067-6.

4. Keil MF. Quality of life and other outcomes in children treated for Cushing syndrome. J Clin Endocrinol Metab 2013;98(7):2667–2678. DOI: 10.1210/jc.2013-1123.

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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