Even when clinical signs of classically described overt Cushing syndrome are not present, patients with adrenal adenomas and less severe hypercortisolism showed an increased risk of cardiovascular events and mortality. A retrospective, single-center study analyzed the risk of cardiovascular events in patients who were grouped based on their post-DST cortisol levels.4
In another multicenter study, a correlation was found between the size of adrenal adenomas and the elevated risk of hypercortisolism and cardiovascular events.
The study observed 206 patients with adrenal adenomas over a 5-year period. Baseline cortisol measurements confirmed hypercortisolism in 24 of the patients (DST cortisol >1.8 µg/dL).
At follow-up, patients with an adenoma ≥2.4 cm in size were more likely to develop hypercortisolism over time. An additional 15 patients (8.2%) progressed into hypercortisolism by study end.
Patients with hypercortisolism were found to be at elevated risk of cardiovascular events.
Excess cortisol promotes bone loss. Hypercortisolism can impact bone mineral density, bone architecture, and bone remodeling, which affects bone strength.6
Hypercortisolism is associated with persistent physical morbidity. CV risk, fatigue, muscle disease (myopathy), and bone fragility negatively impact well-being and quality of life (QoL).7
Excess cortisol can greatly diminish a patient’s quality of life by aggravating several physical and psychological conditions.
of patients experience weight gain7
experience depression, psychosis, and cognitive dysfunction8
fulfill at least 3 criteria for metabolic syndrome9
Predictors for a lowered QoL in patients with hypercortisolism include a delay in getting an accurate diagnosis and the need to see multiple physicians before an accurate diagnosis is made.7