Long-Term Complications of Hypercortisolism

Abstract

Chronic endogenous hypercortisolism is responsible for a rare and severe endocrine disease named Cushing's syndrome (CS). CS can be classified in ACTH-dependent and ACTH-independent forms. The estimated prevalence of CS is 40 cases per million people and the estimated incidence is 0.7–2.4 cases per million people per year. The clinical picture of CS is variable, resulting from a cohort of different signs, including weight gain, moon face, facial plethora, buffalo hump, supraclavicular and dorsal fat pads, purple striae, easy bruising, skin thinning, proximal myopathy, hirsutism, acne and alopecia, as well as symptoms, mainly including asthenia, fatigue and mood disorders. This clinical picture is complicated by several metabolic and cardiovascular comorbidities which, together with thromboembolism, contribute to increase the cardiovascular risk in CS patients. Additional clinical complications include musculoskeletal diseases, immune disorders; neuropsychiatric diseases; impairment of gonadal function. These clinical complications negatively impact on quality of life (QoL) and increase the mortality rate, therefore, a prompt screening, a confirmatory diagnosis and an effective multidisciplinary therapeutic approach are mandatory. Nowadays, the first line treatment for all CS forms still remains surgery, whereas radiotherapy and medical therapy represent a second choice.