Clinical manifestations of hypercortisolism in patients with adrenal Cushing’s

Aim: to evaluate clinical manifestations of hypercortisolism in patients with adrenal Cushing’s (ACush).

Material and Methods. 32 patients (30 (93.7%) female, 2 (6.3%) male, 41.5 [32.2; 54.0] y.o. with ACush.

Results. Adenoma was found in right adrenal in 37.5% of patients, in left – 40.6%, bilateral adenomas in 21.9%. Maximum size of adenoma was 3.3 [3.0;4.2] cm. Level of UFC was 654.1 [383.0;1153.0] nmol/l/h, ACTH – 1.1 [1.1;2.3] pmol/l, serum cortisol after 1-mg overnight dexamethasone suppression test– 644.0 [431.5;710.5] nmol/l. Features that best discriminate Cushing’s syndrome were found not in all patients - proximal muscle weakness - in 81.3%, facial fullness -75.0%, easy bruising - 56.2% and striae - 43.7%. The most frequent (≥80%) complains were weight gain (87.5%), fatigue (84.3%), headache (50-80%). In <50% - poor skin healing, prolonged wound healing, depression, menstrual abnormalities etc. Arterial hypertension diagnosed in 31/32 patients, systolic BP before treatment was 180 [170;220] mm Hg, diastolic BP - 100 [100;110] mm Hg. Antihypertensive therapy: one medication received 5 patients (16.1%), two – 8 (25.8%), three - 12 (38.7%) , four – 1 (3.2%), without therapy - 5 (16.1%). Hypokaliemia were in 26.6%, hypercholesterolemia - 86.6%. In 9 patients diabetes mellitus (DM) diagnosed before diagnosis ACush was made. 75-g OGTT performed in 16 patients without known DM thereafter DM was diagnosed in 2 (12.5%), IGT (impaired glucose tolerance) in 6 (37.5%). Bone densitometry performed in 20 patients: in 5 of them osteoporosis was diagnosed (15.6%), in 5 -osteopenia (15.6%), normal bone density – in 10 (31.2%). Pathological fractures (vertebral, rib fractures etc) were in 3/5 osteoporotic patients.

Conclusions. The most frequent complaints (≥80%) were weight gain, fatigue and proximal muscle weakness. Hypertension and hypercholesterolemia were in 96.9% and 86.6% patients. Diabetes and IGT in 53.1%, hypokaliemia (26.6%), osteoporosis (15.6%).