Question: I didn’t have diabetes, high cholesterol or tri-glycerides during my Cushing’s, but have developed them after my curative surgery, which I think increases my risk for cardiovascular disease. Are those that had Cushing’s predisposed to developing these conditions later in life?  

Answer: It is well known that active Cushing’s increases the risk for developing cardiovascular risks factors, including diabetes, high blood pressure, weight gain, and abnormal cholesterol values. Some studies have suggested that even after successful treatment of Cushing’s, risk for heart disease may still persist in some people, though to a lesser degree than seen in active disease. What you are noting – the new onset of diabetes and high cholesterol after Cushing’s treatment when these conditions had not occurred during active disease – to my knowledge has not been studied or reported specifically. That said, diabetes and high cholesterol are very common conditions in the general population, so it is expected that people with a history of Cushing’s also may develop these conditions not necessarily related to Cushing’s. There are other risk factors to consider including genetic predisposition (if these conditions run in your family), age, and lifestyle (diet, exercise, and amount of sleep you get per day).

Other specific aspects of each case can also play a role in developing the above conditions. For instance, people who are hypopituitary taking endocrine replacement medications need to optimize the doses of each medication in order to mimic normal physiological levels and rhythms as much as possible. Those taking permanent hydrocortisone (or other glucocorticoid replacement) for adrenal insufficiency should take the lowest dose that is safe and does not cause adrenal insufficiency symptoms, since higher doses of glucocorticoid replacement could increase the risk for developing diabetes and high cholesterol. Finally, it is important for people with a history of Cushing’s disease (CD) to have regular follow up with their endocrinologist for serial screening to evaluate for potential Cushing’s recurrence. I recommend follow up at least yearly for patients in remission from CD in order to diagnose a possible recurrence as early as possible. On the other hand, a set of normal test results are reassuring for continued Cushing’s remission.

The above question was answered by Dr. Eliza Geer, Spring, 2015