TY - JOUR
T1 - Glucocorticoid withdrawal syndrome following surgical remission of endogenous hypercortisolism
T2 - A longitudinal observational study
AU - Zhang, Catherine D.
AU - Li, Dingfeng
AU - Singh, Sumitabh
AU - Suresh, Malavika
AU - Thangamuthu, Karthik
AU - Nathani, Rohit
AU - Achenbach, Sara J.
AU - Atkinson, Elizabeth J.
AU - Van Gompel, Jamie J.
AU - Young, William F.
AU - Bancos, Irina
N1 - Publisher Copyright:
© 2023 The Author(s). Published by Oxford University Press on behalf of European Society of Endocrinology. All rights reserved.
PY - 2023/7
Y1 - 2023/7
N2 - Objective: Glucocorticoid withdrawal syndrome (GWS) is a scarcely studied phenomenon that complicates the recovery following surgical remission of hypercortisolism. We aimed to characterize the presence and trajectory of glucocorticoid withdrawal symptoms in the postoperative period and to determine presurgical predictors of GWS severity. Design: Longitudinal observational study. Methods: Glucocorticoid withdrawal symptoms were prospectively evaluated weekly for the first 12 weeks following surgical remission of hypercortisolism. Quality of life (CushingQoL and Short-Form-36) and muscle function (hand grip strength and sit-To-stand test) were assessed at the baseline and at 12 weeks after surgery. Results: Prevalent symptoms were myalgias and arthralgias (50%), fatigue (45%), weakness (34%), sleep disturbance (29%), and mood changes (19%). Most symptoms persisted, while myalgias, arthralgias, and weakness worsened during weeks 5-12 postoperatively. At 12 weeks after surgery, normative hand grip strength was weaker than at baseline (mean Z-score delta-0.37, P =. 009), while normative sit-To-stand test performance improved (mean Z-score delta 0.50, P =. 013). Short-Form-36 Physical Component Summary score worsened (mean delta-2.6, P =. 015), but CushingQoL score improved (mean delta 7.8, P <. 001) at 12 weeks compared to baseline. Cushing syndrome (CS) clinical severity was predictive of postoperative GWS symptomology. Conclusion: Glucocorticoid withdrawal symptoms are prevalent and persistent following surgical remission of hypercortisolism with baseline CS clinical severity predictive of postoperative GWS symptom burden. Differential changes observed in muscle function and quality of life in the early postoperative period may reflect the competing influences of GWS and recovery from hypercortisolism.
AB - Objective: Glucocorticoid withdrawal syndrome (GWS) is a scarcely studied phenomenon that complicates the recovery following surgical remission of hypercortisolism. We aimed to characterize the presence and trajectory of glucocorticoid withdrawal symptoms in the postoperative period and to determine presurgical predictors of GWS severity. Design: Longitudinal observational study. Methods: Glucocorticoid withdrawal symptoms were prospectively evaluated weekly for the first 12 weeks following surgical remission of hypercortisolism. Quality of life (CushingQoL and Short-Form-36) and muscle function (hand grip strength and sit-To-stand test) were assessed at the baseline and at 12 weeks after surgery. Results: Prevalent symptoms were myalgias and arthralgias (50%), fatigue (45%), weakness (34%), sleep disturbance (29%), and mood changes (19%). Most symptoms persisted, while myalgias, arthralgias, and weakness worsened during weeks 5-12 postoperatively. At 12 weeks after surgery, normative hand grip strength was weaker than at baseline (mean Z-score delta-0.37, P =. 009), while normative sit-To-stand test performance improved (mean Z-score delta 0.50, P =. 013). Short-Form-36 Physical Component Summary score worsened (mean delta-2.6, P =. 015), but CushingQoL score improved (mean delta 7.8, P <. 001) at 12 weeks compared to baseline. Cushing syndrome (CS) clinical severity was predictive of postoperative GWS symptomology. Conclusion: Glucocorticoid withdrawal symptoms are prevalent and persistent following surgical remission of hypercortisolism with baseline CS clinical severity predictive of postoperative GWS symptom burden. Differential changes observed in muscle function and quality of life in the early postoperative period may reflect the competing influences of GWS and recovery from hypercortisolism.
KW - Cushing syndrome
KW - glucocorticoid withdrawal
KW - hypercortisolism
KW - myopathy
KW - quality of life
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U2 - 10.1093/ejendo/lvad073
DO - 10.1093/ejendo/lvad073
M3 - Article
C2 - 37395115
AN - SCOPUS:85164284964
SN - 0804-4643
VL - 189
SP - 29
EP - 39
JO - European journal of endocrinology
JF - European journal of endocrinology
IS - 1
ER -