title: Persistence of Cushing's disease symptoms and comorbidities after surgical cure: a long-term, integral evaluation.
abstract: OBJECTIVE
  Successful surgery does not always resolve all the clinical consequences of hypercortisolism in patients with Cushing's disease (CD). Our purpose was to integrally evaluate a group of CD patients cured by pituitary surgery and look for the persistence of CD symptoms, signs, and comorbidities.
  
  
  METHODS
  We performed clinical and biochemical evaluations of 29 CD patients (2 males) cured by pituitary surgery. All patients underwent early (median 12 months) and late (median 58 months) postoperative evaluations. We sought information regarding hypercortisolism-related symptoms and signs, as well as metabolic, cardiovascular, reproductive, and psychologic comorbidities.
  
  
  RESULTS
  The prevalence of obesity dropped from 72.4% at diagnosis to 31% at early evaluation but increased again to 44.8% at the late evaluation. Diabetes was present in 14 patients (48.3%) at diagnosis and persisted in 9 at the late evaluation. Hypertriglyceridemia was present in 58.6% and 55.1% of patients at diagnosis and at the late follow-up, respectively. The prevalence of hypercholesterolemia was 79.3% at diagnosis, decreased to 55.1% at the early evaluation, and increased to 65.5% at the late evaluation. Menstrual abnormalities were originally present in 15 of 20 women, and 8 of the 15 had recovered normal periods when seen at the last evaluation. Among the 24 patients with depression at diagnosis, 11 and 6 still exhibited mood abnormalities at the early and late evaluations, respectively.
  
  
  CONCLUSIONS
  In a variable proportion of patients, the cardiovascular, metabolic, and emotional comorbidities of CD persist after long-term remission, irrespective of the initial degree of hypercortisolism.
authors.affiliation: Endocrinology Section and the Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, México City, Mexico.
authors.forename: Ana Laura
authors.initials: AL
authors.lastname: Espinosa-de-Los-Monteros
authors.forename: Ernesto
authors.initials: E
authors.lastname: Sosa
authors.forename: Nayeli
authors.initials: N
authors.lastname: Martinez
authors.forename: Moisés
authors.initials: M
authors.lastname: Mercado
mesh_terms: D000152:Acne Vulgaris / Q000453:epidemiology / Q000517:prevention & control; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D003480:Cushing Syndrome / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D003863:Depression / Q000453:epidemiology* / Q000517:prevention & control; D005221:Fatigue / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006628:Hirsutism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism / Q000652:urine; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D007008:Hypokalemia / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008599:Menstruation Disturbances / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D010902:Pituitary Gland / Q000378:metabolism / Q000601:surgery*; D015995:Prevalence; D055815:Young Adult
chemical_list: D006854:Hydrocortisone