The frequency of cushi̇ng's di̇sease (CD), acth i̇ndependent cushi̇ng's syndrome (CS) and autonomous corti̇sol secreti̇on (ACS) i̇n obese pati̇ents

OBJECTIVES Obesity is a metabolic disease with increasing prevalence in around world. However, the frequency of Cushing's disease (CD), ACTH independent Cushing's syndrome (CS) and autonomous cortisol secretion (ACS) in patients with obesity is not well known and the results of the studies are heterogenous. Therefore, in the present study we aimed to assess the frequency of CD, CS and ACS among patients with obesity. MATERİAL AND METHOD This was a retrospective study of 813 patients (683 female, 130 male; mean age 46,47± 14,23 yr; mean body mass index 37.31 ± 6.50 kg/m2) who were admitted due to obesity between 2010-2015 to endocrinology and metabolism outpatient clinic of the Namik Kemal University Faculty of medicine. The diagnosis of obesity was made according to BMI and the obesity were classified further to grade 1, 2 and 3, according to the BMI. Serum cortisol levels failed to suppress to < 1.8 μg /dL in 44 (5.4%) patients. These patients were evaluated further by 2 days 2 mg DST, 24 hours urinary free cortisol excretion (UFC), late-night salivary cortisol and plasma ACTH levels. The patients with CD, CS and ACS and those with simple obesity were compared in terms of gender, age, DM, HT and HL. RESULTS Forty four (% 5.4) out of 813 patients were diagnosed as CD, CS or ACS. Five (0.6%) of the patients were lost to follow-up. CD was diagnosed in 4 (0.4%) of 39 patients, according to the laboratory and pituitary MRI results. CS were diagnosed in 2 (%0.2) of 35 patients. Adrenal tumors were found on abdominal imaging studies in both of these patients. All of these patients underwent transsphenoidal and unilateral adrenalectomy. ACS was diagnosed in 33 patients (4%). Among them, two patients underwent unilateral adrenalectomy due to the simultaneous ACS and primary hyperaldosteronism. When patients with CD, CS, and ACS were compared to those with simple obesity, older age at diagnosis, and the presence of stage-1 obesity, HT, DM and uncontrolled DM were significantly higher in patients with CD, CS and ACS ( p = 0.001, p = 0.007, p = 0.004, p = 0.038 and p = 0.026 respectively). CONCLUSION According to the results of the present study, the frequency of CD, CS and ACS is increased among patients with obesity. Therefore, all patients admitted due to obesity should be evaluated in terms of CD, CS and ACS. Further prospective studies with large number of patients are required to assess the frequency of CD, CS and ACS in patients with obesity, to determine the optimal test for diagnosis of these conditions and also to assess the effect of surgery on obesity in these patients. Keywords: Obesity, autonomous cortisol secretion, Cushing's syndrome