MON-318 Acute, Life-Threatening and Perioperative Complications in Cushing’s Syndrome: Predictors and Outcomes
Authors: Schernthaner-Reiter Marie Helene , Siess Christina , Alexander Micko , Wolfsberger Stefan , Scheuba Christian , Riss Philipp , Knosp Engelbert , Kautzky-Willer Alexandra , Luger Anton , Vila Greisa 
Published: May 2020

Introduction

Cushing’s syndrome is associated with significant chronic and acute comorbidities including acute thromboembolic and cardiovascular events. To date, there are no data on the prevalence and predictors of acute and perioperative complications in patients with active Cushing’s syndrome.

Methods

In a single-center cohort analysis we evaluate predictors and outcomes of acute, life-threatening and perioperative complications in patients with active biochemically verified Cushing’s syndrome attending our endocrine department between 1978 and 2016. Any medical complications necessitating hospitalization, including admission to intensive care units (ICUs), from the time of appearance of first symptoms of hypercortisolism until one year after biochemical remission by surgery (or where surgical remission was not achieved, during continuing follow-up) were recorded and classified. Baseline factors related to and predicting acute complications were tested using uni- and multivariate analysis.

Results

The study included 242 patients (m/f n=54/188) with Cushing’s syndrome (pituitary n=99, adrenal n=116, ectopic n=27), 14.0% of which had malignant disease.

At least one acute complication was observed in 54.5% of patients; these included electrolyte disturbances (24.4%), infections (27.7%), thromboembolic events (14.9%), cardiac arrhythmias necessitating medical intervention (5.4%), hypertensive crises (8.7%), acute coronary events (3.3%) and cerebrovascular events (4.1%). At least one ICU admission (excluding post-surgical observance) was required in 13.2% of patients. The majority of complications occurred prior to surgery (60-90%); infections occurred pre- and postoperatively (51.7% vs 48.3%, respectively).

Patients with ectopic Cushing’s syndrome demonstrated a higher likelihood of infection (p&lt;0.001), hypokalemia (p&lt;0.001) and ICU stays (p=0.009) compared to patients with pituitary or adrenal Cushing’s syndrome. Patients with diabetes mellitus at diagnosis (n=81) had a significantly higher frequency of infection (p&lt;0.001), hypokalemia (p&lt;0.001), hypertensive crises (p=0.004), acute coronary events (p=0.029), arrhythmias (p=0.025) and a higher likelihood of an ICU stay (p&lt;0.001).

The total number of acute complications and the number of days at ICU correlated positively with parameters of cortisol excess including urinary free cortisol and the time of hypercortisolism.

Conclusion

This cohort analysis identifies a significantly high prevalence of acute and perioperative complications in Cushing’s syndrome, with one in eight patients suffering a life-threatening situation necessitating ICU admission. These acute complications are positively predicted by the degree of hypercortisolism, emphasizing the necessity for acute interventions aiming to reduce cortisol excess even before definitive disease cure is achieved.