THU034 Severe Obesity In Cushing´s Disease In A Tertiary Center: Current Prevalence And Diagnostic Implications
Authors: Mascarenhas-Nakano Bruna Maria Grosso , Correa-Silva Silvia Regina , Santos-Neto Pedro Felisberto , Corrêa Portari Luiz Henrique , Abucham Julio 
Published: October 2023

Abstract
Disclosure: B.M. Mascarenhas-Nakano: None. S.R. Correa-Silva: None. P.F. Santos-Neto: None. L.C. Portari: None. J. Abucham: None.
Introduction: The prevalence of obesity in the general population has increased dramatically and severe obesity (SO) has become more frequent. Weight gain and obesity are common features of endogenous hypercortisolism but prevalence of SO in that condition was reportedly low in the past. Under the current "obesity epidemics", however, the prevalence of SO in patients with hypercortisolism has not been reassessed. Coexistence of both conditions may have diagnostic and therapeutic implications. Aims: To calculate prevalence of SO (BMI≥40kg/m2) in patients recently diagnosed with Cushing’s disease (CD), the most common form of endogenous hypercortisolism, and to describe/compare their characteristics with CD patients without SO. Patients and Methods: We retrospectively evaluated 68 sequential patients (59 F) with surgically proven CD (2000-2020). Disease severity was classified by a clinical score. Urinary free cortisol (UFC) [ratio to upper limit of normality (ULN)], late-night salivary cortisol (LNSC) and 1mg dexamethasone suppression test (DST) were analyzed. Statistics: Student´s, Mann Whitney, Chi-square, Fisher´s, Spearman, and Pearson tests. Results: mean±SD. P&lt;0.05: significant. 0.05&lt;P&lt;0.10: tendency. Results: Prevalence, Age, and BMI. Ten patients (all women) had SO. Prevalence: 15%. Age was not different (37.7±8.6y vs 32.8± 10.9y, P=0.18). BMI: 42.4±2.2 vs 28.9±4.4 (P&lt;0.0001). Duration and Severity. Disease duration was longer (5.3±3.3y vs 2.5±2.5y, P=0.006) and tended to correlate with BMI (r=0.28, P=0.05). Severity tended to be milder (P=0.08). Comorbities. Prevalences of diabetes mellitus and hypertension were not different (0.50&lt;P&lt;0.57). Tumor. Largest tumor diameter was not different (P=0.98). Diagnostic tests. Overall, false-negative rates were higher (P=0.02) for UFC (12%) as compared to LNSC (2.3%) and DST (1.6%), and UFC correlated inversely with BMI (r=-0.30, P=0.016). UFC false-negative results tended to cluster in severe obesity (3/10 vs 5/58, P=0.09). LNSC, cortisol after dexamethasone, and ACTH showed no differences between groups (0.79&lt;P&lt;0.91). White blood cells. The difference between Neutrophil and Lymphocyte counts (Ne-Ly), recently described as a marker of hypercortisolism was elevated in 100% of patients in the SO group and in 85% in the other group. Conclusion: The 15% prevalence of SO found in our series of CD patients is substantial. Overall, patients with CD and SO presented with longer disease duration, clinically less severe disease, and higher false-negative rates in UFC. Conventional screening for hypercortisolism in SO is not considered cost-effective, but patients with SO and unrecognized hypercortisolism have been submitted to bariatric surgery. A simple calculation using WBC, a test usually at hand, may be a valuable and cost-effective pre-screening test. Our data and conclusions await confirmation in larger series.
Presentation: Thursday, June 15, 2023