The Effect of Curative Treatment on Hyperglycemia in Patients With Cushing Syndrome

Justine Herndon; Ravinder Jeet Kaur; Mark Romportl; Emily Smith; Amy Koenigs; Brenda Partlow; Leonardo Arteaga; Irina Bancos

doi:10.1210/jendso/bvab169

The Effect of Curative Treatment on Hyperglycemia in Patients With Cushing Syndrome

J Endocr Soc. 2021 Dec 2;6(1):bvab169. doi: 10.1210/jendso/bvab169. eCollection 2022 Jan 1.

Authors

Justine Herndon¹, Ravinder Jeet Kaur², Mark Romportl¹, Emily Smith¹, Amy Koenigs¹, Brenda Partlow¹, Leonardo Arteaga¹, Irina Bancos^{1

3}

Affiliations

¹ Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, Minnesota 55905, USA.
² Division of Endocrine Research, Mayo Clinic, Rochester, Minnesota 55905, USA.
³ Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA.

Abstract

Context: Hyperglycemia is a common complication of Cushing syndrome (CS).

Objective: We aimed to determine the impact of curative procedure on hyperglycemia and its management in patients with CS.

Methods: This retrospective longitudinal cohort study took place 2000 to 2019 in a referral center among adults with endogenous CS and hyperglycemia. Main outcome measures included glycated hemoglobin A_1c (HbA1c), intensity of hyperglycemia therapy, and improvement of hyperglycemia.

Results: In 174 patients with CS (pituitary in 106, ectopic in 25, adrenal in 43), baseline median HbA_1c was 6.9% (range, 4.9-13.1), with 41 (24%) patients not on any therapy for hyperglycemia, 93 (52%) on oral medications, and 64 (37%) on insulin (median daily units of 58; range, 10-360). Following CS remission, at the end of follow-up (median 10.5 months), 37 (21%) patients demonstrated resolution of hyperglycemia, 82 (47%) demonstrated improvement, and 55 (32%) had no change or worsening in hyperglycemia. At the end of follow-up, HbA_1c decreased by 0.84% (P < .001) and daily insulin dose decreased by a mean of 30 units (P < .001). Biochemical hypercortisolism severity score (severe vs moderate/mild: odds ratio [OR] of 2.4 [95% CI, 1.1-4.9]), and CS subtype (nonadrenal vs adrenal: OR of 2.9 [95% CI, 1.3-6.4]), but not type of hyperglycemia (diabetes vs prediabetes: OR of 2.1 [0.9-4.9]) were associated with hyperglycemia improvement at the end of follow-up.

Conclusion: Two-thirds of patients with CS and hyperglycemia demonstrate resolution or improvement of hyperglycemia after a curative procedure. Close monitoring during CS recovery is needed to ensure appropriate therapy modification.

Keywords: HbA1c; diabetes mellitus; hypercortisolism; improvement; outcome; surgery.