Surgery reverses hypogonadism in majority of men with Cushing syndrome

A recent study has found that hypogonadism, a common condition in men with Cushing syndrome, can be significantly reversed following surgical treatment, with approximately 75% of patients experiencing recovery within one-year post-surgery.

The study, which conducted a post-hoc analysis of prospective cohort studies at a clinical research center, included two cohorts: Cohort 1 (C1) with 8 men studied from 1985 to 1989, and Cohort 2 (C2) with 44 men studied from 1989 to 2021.

In Cohort 1, participants underwent 24-hour blood sampling before and up to 40 months after surgery, with 3 undergoing GnRH stimulation tests both before and after surgery. Post-surgery, a significant increase in mean luteinizing hormone (LH) and LH pulse frequency was observed (P < 0.05), while there were no changes in LH pulse amplitude, mean FSH, or peak gonadotropin response to GnRH.

For Cohort 2, hormone levels were measured at the beginning of the study and at 6 and 12 months post-surgery. Initially, 82% of participants exhibited baseline hypogonadism (total testosterone 205 ± 28 ng/dL). Thyroid hormone levels showed an inverse relationship with UFC and cortisol levels. Although levels of LH, total and free testosterone, and SHBG increased at 6 and 12 months post-surgery, hypogonadism persisted in 51% of patients at 6 months and 26% at 12 months.

Reference
Shekhar S, McGlotten RN, Cutler GB Jr, Crowley MJ, Pieper CF, Nieman LK, Hall JE. Longitudinal Evaluation of Reproductive Endocrine Function in Men with ACTH-Dependent Cushing Syndrome. J Clin Endocrinol Metab. 2024;dgae497. doi: 10.1210/clinem/dgae497. Epub ahead of print. PMID: 39013141.