Deterioration Of Blood Lipids During Early Postoperative Remission Of Cushing's Syndrome: A Longitudinal Cohort Study

CONTEXT: Cushing's syndrome (CS) is associated with an unfavorable lipid profile. However, data on lipid alterations during early postoperative remission, a particularly cardiovascular vulnerable period, are lacking. OBJECTIVE: Evaluation of lipid profiles during active CS and the early postoperative period. PATIENTS AND METHODS: In this single-center cohort study at LMU Hospital, Munich, we analyzed lipid profiles (total cholesterol, LDL, HDL, ApoA1, ApoB, lipoprotein (a), triglycerides, and non-esterified fatty acids) and metabolic markers in 26 patients with endogenous CS before surgery and 1, 3, 6, 12 and 24 months (n = 23) after curative surgery and compared them with 26 age-, BMI-, and sex-matched controls without hypercortisolism at baseline. RESULTS: Paradoxically, most lipid parameters worsened postoperatively. One month following surgery, HDL (1 month postoperative 38 mg/dL [35-46] vs. active CS 49.5 mg/dL [45-61.3], P < .0001) and ApoA1 concentrations (1-month postoperative 160 mg/dL [147-168] vs. active CS 193 mg/dL [169-211], P < .0001) were significantly lower compared to preoperative levels. Similarly, 1-month following surgery triglycerides concentrations (1-month postoperative 185 mg/dL [154-218] vs. active CS 129 mg/dL [89.3-186] preoperatively, P < .0001) were higher. These changes remained evident until 6 months post-surgery. The triglyceride-glucose index increased during early remission and showed a positive correlation with inflammatory markers CRP and IL-6. Non-esterified fatty acids displayed 3 distinct postoperative trajectories depending on BMI at baseline. CONCLUSION: During the early remission phase following curative surgery for CS, we observed a further deterioration in lipid parameters. This can affect cardiovascular health and provide the basis for targeted therapy.