Microalbuminuria in Cushings syndrome: remission after correction of hypercortisolemia

Koh, Jung Min; Chung, Yun Ey; Park, Joong Yeol; Shong, Yung Kee; Hong, Sung Kwan; Kim, Ghi Su; Lee, Ki Up

Abstract

OBJECTIVES
Microalbuminuria predicts cardiovascular mortality in patients with non-insulin-dependent diabetses mellitus (NIDDM). Microalbuminuria is frequently associated with high blood pressure, dyslipidemia, insulin resistance and central obesity, and has been suggested to be a feature of metabolic syndrome (syndrome X). Metabolic syndrome is also present in Cushings syndrome, which is characterized by primary hypercortisolism as well as profound visceral obesity. Considering common features of Cushings syndrome and metabolic syndrome, microalbuminuria could be a feature of Cushings syndrome.
METHODS
We studied urinary albumin excretion (UAE) in 13 patients with Cushings syndrome. UAE was reexamined after the correction of hypercortisolemia in the patients with microalbuminuria or overt proteinuria. Kidney biopsy was performed in 3 patients with microalbuminuria.
RESULTS
Eight out of 13 patients (61.5 %) had microalbuminuria. Kidney biopsy revealed apparently normal glomerular structures without evidence of diabetic or hypertensive nephropathy. Patients underwent successful removal of pituitary or adrenal tumors and were reevaluated 2 months after surgery. UAE declined profoundly in all of the patients with initial microalbuminuria.
CONCLUSION
Our results demonstrate that more than 60% of patients with Cushings syndrome have microalbuminuria. This rate far exceeds the rate in NIDDM patients and hypertensive patients. Microalbuminuria nearly completely reversed after successful treatment of hypercortisolism.