Home Medizin Erhöhtes Risiko einer Autoimmunerkrankung nach Remission des Cushing-Syndroms

Erhöhtes Risiko einer Autoimmunerkrankung nach Remission des Cushing-Syndroms

von NFI Redaktion


A study conducted with more than 250 individuals who underwent surgical therapy for Cushing’s disease (CD) or non-functioning pituitary adenomas (NFPAs) revealed that patients who achieved remission of CD were more likely to develop a newly occurring autoimmune disease within 3 years compared to patients with surgically treated NFPAs after remission. The study is published in the Annals of Internal Medicine.

CD results from excessive production of corticotropin (ACTH) by a pituitary adenoma, causing hypercortisolism. Transsphenoidal surgery (TSS) is the initial treatment for most hypersecreting pituitary adenomas. After TSS for CD, adrenal insufficiency occurs once the ACTH-secreting tumor is removed. While signs and symptoms of hypercortisolism typically improve over time following remission of CD, steroid withdrawal symptoms may develop. Furthermore, the development of a new autoimmune disease in patients after CD remission has been observed, but research is limited.

Researchers from Harvard Medical School identified 194 individuals with CD and 92 individuals with NFPA who underwent pituitary surgery, with frequencies adjusted for age and gender. The authors found that individuals with CD who achieved remission were more likely to develop a newly occurring autoimmune disease within 3 years following remission compared to individuals with surgically treated NFPAs. The cumulative incidence was 10.4 percent. According to the authors, the higher prevalence of adrenal insufficiency and lower serum cortisol nadir levels in the CD group suggest that postoperative adrenal insufficiency may have contributed to the development of autoimmune diseases. They also point out that individuals with CD who have a family history of autoimmune diseases should be carefully monitored after achieving remission. Additionally, the authors suggest that higher doses of early postoperative glucocorticoid replacement may be associated with a lower risk of developing an autoimmune disease. These findings have implications for understanding the natural course of autoimmune diseases and their relationship to cortisol fluctuations.

Source:

American College of Physicians

Journal Reference:

Nyanyo, DD, et al. (2024) Autoimmune Diseases Linked to Surgical Remission of Cushing’s Disease Annals of Internal Medicine. doi.org/10.7326/M23-2024.

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