Investigetion of metabolic complications after operation in patients with operated cushing disease, adrenal cushing syndrome or subclinic cushing syndrome

Endogenous Cushing Syndrome is a rare disease, with an estimated incidence of 0.7-2.4 millon per year. The clinical presentation is highly variable. While the diagnosis can be straightforward in florid cases, establising the diagnosis can be challenging in cases with mild hypercortisolism and subtle clinical features. Cortisol excess can cause irreversible damage of organs and system and Cushing's Syndrome can lead to significant metabolic morbidity and mortality if not treated. Metabolic problems during the course of Cushing's Syndrome and Subclinical Cushing Syndrome have been evaluated in many studies. However, since the hypercortisolemia of these patients has decreased in the post-surgical period, the follow-up of patients who have metabolic complications is not tight and this delay the detection of the development or worsening of possible metabolic complications in patients with risk. The aim of this study was to determine whether the comorbidities associated with glucocorticoid excess resolved after corticotropic axis improvement in patients with Adrenal Cushing Syndrome, Hypophyseal Cushing Disease And Subclinical Cushing Syndrome. In our study, although hypercortisolemia was resolved in people who had been exposed to excess cortisol, metabolic comorbidities such as DM and HT persisted in the early and late follow-up period. Materials and Methods The patients were included in the study who follow in the outpatient clinic with diagnosis of Cushing's Syndrome or Subclinical Cushing Syndrome.For metabolic and hormonal evaluation, basal ACTH, basal cortisol and overnight 1 mg DST performed. Patients were questioned in terms of metabolic comorbidity. Patients with using oral antidiabetic / insulin were included in the diabetic group, and the need for medication in the postoperative follow-up period was questioned and recorded. Patients with pre-operative antihypertensive usage were included in the hypertensive patient group, and the need for medication during the postoperative follow-up period was questioned and recorded. For the diagnosis of coronary artery disease, the patient was questioned about whether the medication intake / PTCA procedure / surgery was performed or not. Results A total of 63 patients were included in our study, 17 of them were Adrenal Cushing's Syndrome, 24 with Pituitary Cushing's Disease and 22 with Subclinical Cushing Syndrome.39.7% of the patients had DM, 57% had HT and 6.3% had Cardiovasculer disease. The only effective factor for the worsening of the disease course in diabetic and hypertensive patients after the operation was remission. It was concluded that the age, BMI and follow-up period at the time of diagnosis did not significantly contribute to the development or worsening of diabetic disease in patients with Cushing Syndrome. Conclusions In our study, although hypercortisolemia was eliminated in people who had been exposed to hypercortisolemia, metabolic comorbidities such as DM and HT were found to persist at the earliest 12 months follow-up. In the literature, there is no sufficient study with this issue so long-term clinical studies with high number of cases needed for more realiable data.