Endogenous Cushing’s syndrome is a severe and rare condition caused by chronic exposure to excess cortisol, with an estimated annual incidence of 2-3/1000'000. It is classically divided into ACTH-dependent (80% of cases), 80% of which are caused by Cushing’s disease and 20% of which by ectopic ACTH secretion, and ACTH-independent (remaining 20%). It is associated with high morbidity and mortality, and its varied and not always specific clinical presentation can contribute to delayed diagnosis. Experienced physicians are required both for its diagnosis and its treatment, and patients should be monitored long term due to the risk of recurrence. Among many other clinical features, Cushing’s syndrome can interfere with hypothalamus-pituitary-thyroid axis, causing clinical features like those of central hypothyroidism, furthermore, some studies have shown an increased prevalence of thyroid nodules. The aim of our study was to confront the prevalence and the features of thyroid nodules in Cushing’s syndrome patients with those of a control group made of acromegalic patients, whose increased risk of thyroid nodules is known. Furthermore, we aimed to evaluate thyroid function in Cushing’s syndrome patients during active disease, one year after surgery, and at long term follow up after surgery. Our study population initially included 125 patients, of whom we excluded 20 due to insufficient data, and 113 acromegaly patients as a control group. TSH value of patients in remission was significantly greater than that of patients with active or persistent disease, however, we found conflicting results trying to correlate TSH value to adrenal hormones, which can be partially explained by their high intraindividual variability. The prevalence of thyroid nodules in Cushing’s syndrome patients was inferior to that of acromegaly patients, however, the prevalence of differentiated thyroid cancer was not statistically different among the two groups.
La sindrome di Cushing endogena è una patologia rara caratterizzata da prolungata esposizione a eccesso di cortisolo, con incidenza compresa tra 2 e 3 casi per milione abitanti/anno. Nell’80% dei casi è ACTH-dipendente, (80% malattia di Cushing, 20% da secrezione ectopica di ACTH) e nel restante 20% dei casi ACTH-indipendente. Si associa a elevate morbilità e mortalità, e la presentazione clinica variegata e non sempre specifica può portare a importante ritardo diagnostico. Richiede una gestione specialistica sia per la diagnosi che per il trattamento e va monitorata nel lungo termine per il rischio di recidive. Tra le manifestazioni cliniche dell’ipercortisolismo vi è anche un effetto sull’asse ipotalamo-ipofisi-tiroide, con caratteristiche simili a quelle dell’ipotiroidismo centrale, inoltre, alcuni studi hanno osservato un’aumentata prevalenza di nodi tiroidei. Gli obiettivi del nostro studio sono: il confronto di prevalenza e caratteristiche dei nodi tiroidei in pazienti con sindrome di Cushing con quella di un gruppo di controllo costituito da pazienti acromegalici, a noto rischio aumentato; la valutazione della funzionalità tiroidea in pazienti con sindrome di Cushing in fase attiva di malattia, a un anno dalla chirurgia, e a un lungo follow up dopo la chirurgia. Nella nostra popolazione di studio abbiamo valutato inizialmente 125 pazienti con sindrome di Cushing, di cui 20 sono stati esclusi per dati insufficienti, e 113 controlli con acromegalia. Il TSH dei pazienti in remissione dall’ipercortisolismo è risultato significativamente maggiore di quelli in fase attiva o in persistenza di malattia, tuttavia, la ricerca di correlazione con gli indici di funzionalità corticosurrenalica ha fornito risultati discordanti, spiegati anche dalla loro elevata variabilità intraindividuale. La prevalenza di noduli tiroidei nei pazienti con sindrome di Cushing è risultata inferiore a quella dei controlli acromegalici, mentre non sono state osservate differenze significative nella prevalenza di carcinoma differenziato della tiroide.
Studio morfologico e funzionale tiroideo nei pazienti con sindrome di Cushing
D'ANGELO, PAOLO
2023/2024
Abstract
Endogenous Cushing’s syndrome is a severe and rare condition caused by chronic exposure to excess cortisol, with an estimated annual incidence of 2-3/1000'000. It is classically divided into ACTH-dependent (80% of cases), 80% of which are caused by Cushing’s disease and 20% of which by ectopic ACTH secretion, and ACTH-independent (remaining 20%). It is associated with high morbidity and mortality, and its varied and not always specific clinical presentation can contribute to delayed diagnosis. Experienced physicians are required both for its diagnosis and its treatment, and patients should be monitored long term due to the risk of recurrence. Among many other clinical features, Cushing’s syndrome can interfere with hypothalamus-pituitary-thyroid axis, causing clinical features like those of central hypothyroidism, furthermore, some studies have shown an increased prevalence of thyroid nodules. The aim of our study was to confront the prevalence and the features of thyroid nodules in Cushing’s syndrome patients with those of a control group made of acromegalic patients, whose increased risk of thyroid nodules is known. Furthermore, we aimed to evaluate thyroid function in Cushing’s syndrome patients during active disease, one year after surgery, and at long term follow up after surgery. Our study population initially included 125 patients, of whom we excluded 20 due to insufficient data, and 113 acromegaly patients as a control group. TSH value of patients in remission was significantly greater than that of patients with active or persistent disease, however, we found conflicting results trying to correlate TSH value to adrenal hormones, which can be partially explained by their high intraindividual variability. The prevalence of thyroid nodules in Cushing’s syndrome patients was inferior to that of acromegaly patients, however, the prevalence of differentiated thyroid cancer was not statistically different among the two groups.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/65981