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Age‐dependent decline in cortisol levels and clinical manifestations in patients with ACTH‐independent Cushing's syndrome
Author(s) -
Mayumi Katayama,
Kazuhiro Nomura,
Makoto Ujihara,
Takao Obara,
Hiroshi Demura
Publication year - 1998
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1046/j.1365-2265.1998.00551.x
Subject(s) - medicine , endocrinology , adrenal adenoma , cushing syndrome , hydrocortisone , hirsutism , urinary system , adenoma , creatinine , insulin resistance , polycystic ovary , insulin
OBJECTIVE Adrenocortical cells change with age in both subcellular morphology and level of steroidogenesis. This study evaluates the influence of aging on hypercortisolism and clinical manifestations in patients with ACTH‐independent Cushing's syndrome due to a cortisol‐secreting adrenal adenoma (CS). DESIGN Restrospective study. PATIENTS Thirty‐six (33 females and 3 males) with CS. 31 healthy controls were age‐ and sex‐matched to CS patients. MEASUREMENT Patient age at diagnosis was compared to the degree of hypercortisolism and clinical manifestations. The degree of hypercortisolism was estimated using serum cortisol levels and urinary free cortisol excretion. Positive clinical manifestations were quantified using 12 symptoms and signs which resulted in a clinical score for each patient. Endogenous creatinine clearance, estimated disease duration and gender were analysed as possible factors affecting adenoma‐secreated cortisol. RESULTS Patient age correlated negatively with serum cortisol level ( r = −0.417, P = 0.0107, n = 36) and urinary excretion of free cortisol ( r = −0.613, P = 0.0002, n = 31). Analysis of Spearman's rank correlation showed that the clinical score decreased with age (ρ = −0.631, P = 0.0004, n = 33). Oedema, weakness/myopathy, hirsutism, striae and psychological changes were infrequent symptoms in the elderly. Using stepwise multiple regression analysis, we estimated the clinical score ( Y ) by factors of serum cortisol levels ( X 1 :nmol/l), age ( X 2 : years of age) and gender ( X 3 : gender; female = 1, male = 0), i.e. Y = 4.771 + 0.004 X 1 − 0.064 X 2 + 2.548 X 3 ( r = 0.743, P < 0.0001, n = 33). Results suggested that aging both suppressed cortisol secretion and repressed manifestations directly as an independent factor, although its direct effect may be weak. CONCLUSIONS Our findings indicated the importance of age as a factor modulating hormonal levels and possible clinical manifestations in patients with cortisol‐secreting adenomas.