2025 Proffered Presentations
S043: CHARACTERIZATION OF THE CORTISOL WITHDRAWAL SYNDROME AFTER SUCCESSFUL CUSHINGS DISEASE SURGERY
Adam Z Levitan, BSc1; Jai Sethi2; Janissardhar Skulsampaopol, MD3; Jeannette Goguen, MD, MEd, FRCPC1; Michael D Cusimano, MD, PhD, MHPE, FRCS, DABNS, FACS1; 1University of Toronto; 2Royal College of Surgeons Ireland; 3Mahidol University
Background: Successful surgery for Cushing’s Disease (CD) leads to a sudden change in cortisol levels and patients often experience a constellation of symptoms consistent with the abrupt change in cortisol levels, a condition we term cortisol withdrawal syndrome (CWS). The goal of this study was to characterize CWS by examining changes in quality of life (QoL) before and after successful surgery.
Methods: Using a CD-specific questionnaire we developed, changes in QoL in the early postoperative period (2.6±1.2 months), compared to before surgery, were investigated in 33 CD patients who underwent successful surgery. Item- and domain-level changes in QoL were investigated using t-tests and correlation matrices. A Euclidean hierarchical analysis was used to identify latent subgroups of QoL changes. Linear regressions tested the effect of follow-up duration, BMI and pre-operative cortisol levels on changes in QoL.
Results: Worsened appetite was the only significant item-level change in the early postoperative group (t(32) = -2.39, p = 0.023). Changes in the “stretch marks” item correlated with changes in the “facial hair” item (r(31) = 0.70, 95% CI [0.46-0.84], p < 0.001). Changes in the physical health domain were significantly correlated with changes in emotional health (r(31) = 0.56, 95% CI [0.27-0.76], p < 0.001) and general health (r(31) = 0.52, 95% CI [0.21-0.73], p = 0.002). The cluster analysis yielded six distinct subgroups. QoL worsened across all domains except social well-being, especially mental status, in the largest subgroup (n=8, 24%). Conversely, the smallest subgroup (n=2, 6%) experienced pronounced improvements across almost all domains. The four remaining subgroups experienced moderate changes in distinct combinations of QoL domains.
Discussion: Our study is the first to investigate associations between changes in the items and domains that comprise QoL in this patient group. Furthermore, we describe novel subgroups of QoL changes after successful CD treatment. Future studies should investigate the clinical factors that characterize these subgroups. Thus, large-sample longitudinal studies are needed to investigate the detailed QoL changes caused by CD.