title: The degree of urinary hypercortisolism is not correlated with the severity of cushing's syndrome.
abstract: Cushing syndrome (CS) is characterized by increased morbidity and mortality compared to the general population. However, there are patients who have more clinical aggressive forms than others. Aim of the study is to evaluate whether the degree of hypercortisolism, defined by the number of times urinary free cortisol (UFC) levels exceed the upper limit of the normal range (ULN), is related to the worsening of phenotypic features, as well as metabolic and cardiovascular parameters, in a cohort of CS patients. A cross-sectional study was conducted on 192 patients with active CS, consecutively presenting at the outpatients' clinic of the University Hospitals of Ancona, Naples, and Palermo. Patients were grouped into mild (UFC not exceeding twice the ULN), moderate (2-5 times the ULN), and severe (more than 5 times the ULN) hypercortisolism. Thirty-seven patients (19.3 %) had mild, 115 (59.8 %) moderate, and 40 (20.9 %) severe hypercortisolism. A significant trend of increase among the three groups was demonstrated for 8-, 16-, and 24-h serum cortisol levels (p < 0.001) and serum cortisol after low dose of dexamethasone suppression test (p = 0.001). No significant trend of increase was found regarding phenotype and comorbidities. The degree of hypercortisolism by itself does not appear to be a sufficient parameter to express the severity of CS. Therefore, estimating the severity of CS according to biochemical parameters remains a challenge, while the clinical phenotype and the associated comorbidities might be more useful to assessing the severity of the CS.
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Sezione di Endocrinologia, Diabetologia e Malattie Metaboliche, Università degli Studi di Palermo, Palermo, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Guarnotta
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Sezione di Endocrinologia, Diabetologia e Malattie Metaboliche, Università degli Studi di Palermo, Palermo, Italy.
authors.forename: Marco C
authors.initials: MC
authors.lastname: Amato
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Pivonello
authors.affiliation: Clinica di Endocrinologia e del Metabolismo, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Arnaldi
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Sezione di Endocrinologia, Diabetologia e Malattie Metaboliche, Università degli Studi di Palermo, Palermo, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ciresi
authors.affiliation: Clinica di Endocrinologia e del Metabolismo, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Trementino
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Sezione di Endocrinologia, Diabetologia e Malattie Metaboliche, Università degli Studi di Palermo, Palermo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Citarrella
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Iacuaniello
authors.affiliation: Clinica di Endocrinologia e del Metabolismo, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy.
authors.forename: Grazia
authors.initials: G
authors.lastname: Michetti
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Simeoli
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Colao
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Sezione di Endocrinologia, Diabetologia e Malattie Metaboliche, Università degli Studi di Palermo, Palermo, Italy. carla.giordano@unipa.it.
authors.forename: Carla
authors.initials: C
authors.lastname: Giordano
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003480:Cushing Syndrome / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D003907:Dexamethasone; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D003907:Dexamethasone; D006854:Hydrocortisone
keywords: Cushing syndrome comorbidities; Cushing syndrome severity; Degree of hypercortisolism; Urinary free cortisol