title: Gender-dependent changes in haematological parameters in patients with Cushing's disease before and after remission.
abstract: OBJECTIVE
  Glucocorticoids stimulate several steps in red blood cell (RBC) development; however, little is known on changes in erythroid parameters in patients with Cushing's disease. The aim of this study was to assess both RBC and white blood cell (WBC) parameters in a large cohort of patients with Cushing's disease and report on alterations in the active phase and after surgical remission.
  
  
  METHODS
  A total of 80 patients with Cushing's disease (63 women and 17 men) were studied before and for up to 254 months' follow-up (mean follow-up 65.8 ± 6.71 months) after pituitary/adrenal surgery. Details of blood counts were reviewed and compared with data obtained from a database of healthy subjects.
  
  
  RESULTS
  The RBC counts and haemoglobin levels were low in men with active Cushing's disease (over 80% of values in the lowest quartile) and four patients were overtly anaemic, whereas erythrocyte counts and haemoglobin levels were evenly distributed across the normal range in women with active Cushing's disease. Low erythroid parameters were linked to hypogonadism in men with Cushing's disease. Recovery in erythroid parameters occurred slowly after remission of hypercortisolism in men, in parallel with improvements in testosterone levels. Over 50% of patients with active disease presented increased WBC counts, irrespective of gender, and prompt normalisation within 1 month after surgery.
  
  
  CONCLUSIONS
  Male patients with Cushing's disease present reduced RBC counts and haemoglobin levels, associated with low testosterone concentrations, which resolve over time after remission of hypercortisolism. Anaemia should therefore be regarded as another unfavourable feature in men with Cushing's disease.
authors.affiliation: Neuroendocrinology Research Laboratory, Istituto Auxologico Italiano IRCCS, Piazzale Brescia 20, 20149 Milan, Italy.
authors.forename: Alberto Giacinto
authors.initials: AG
authors.lastname: Ambrogio
authors.forename: Martina
authors.initials: M
authors.lastname: De Martin
authors.forename: Paola
authors.initials: P
authors.lastname: Ascoli
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavagnini
authors.forename: Francesca
authors.initials: F
authors.lastname: Pecori Giraldi
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000209:etiology; D004906:Erythrocyte Count; D005260:Female; D005938:Glucocorticoids / Q000494:pharmacology; D006410:Hematopoiesis / Q000187:drug effects; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000097:blood* / Q000150:complications / Q000601:surgery*; D012727:Sex Characteristics; D013739:Testosterone / Q000097:blood
chemical_list: D005938:Glucocorticoids; D006454:Hemoglobins; D013739:Testosterone