Endocrinol Metab.  2017 Sep;32(3):353-359. 10.3803/EnM.2017.32.3.353.

The Eosinophil Count Tends to Be Negatively Associated with Levels of Serum Glucose in Patients with Adrenal Cushing Syndrome

Affiliations
  • 1Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea. jmpbooks@cnuh.co.kr
  • 2Research Center for Endocrine and Metabolic Diseases, Chungnam National University School of Medicine, Daejeon, Korea.

Abstract

BACKGROUND
Cushing syndrome is characterized by glucose intolerance, cardiovascular disease, and an enhanced systemic inflammatory response caused by chronic exposure to excess cortisol. Eosinopenia is frequently observed in patients with adrenal Cushing syndrome, but the relationship between the eosinophil count in peripheral blood and indicators of glucose level in patients with adrenal Cushing syndrome has not been determined.
METHODS
A retrospective study was undertaken of the clinical and laboratory findings of 40 patients diagnosed with adrenal Cushing syndrome at Chungnam National University Hospital from January 2006 to December 2016. Clinical characteristics, complete blood cell counts with white blood cell differential, measures of their endocrine function, description of imaging studies, and pathologic findings were obtained from their medical records.
RESULTS
Eosinophil composition and count were restored by surgical treatment of all of the patients with adrenal Cushing disease. The eosinophil count was inversely correlated with serum and urine cortisol, glycated hemoglobin, and inflammatory markers in the patients with adrenal Cushing syndrome.
CONCLUSION
Smaller eosinophil populations in patients with adrenal Cushing syndrome tend to be correlated with higher levels of blood sugar and glycated hemoglobin. This study suggests that peripheral blood eosinophil composition or count may be associated with serum glucose levels in patients with adrenal Cushing syndrome.

Keyword

Cushing syndrome; Eosinophils; Hydrocortisone; Glucose level

MeSH Terms

Blood Cell Count
Blood Glucose*
Cardiovascular Diseases
Chungcheongnam-do
Cushing Syndrome*
Eosinophils*
Glucose
Glucose Intolerance
Hemoglobin A, Glycosylated
Humans
Hydrocortisone
Leukocytes
Medical Records
Pituitary ACTH Hypersecretion
Retrospective Studies
Blood Glucose
Glucose
Hydrocortisone

Figure

  • Fig. 1 Preoperative and postoperative eosinophil population in patients with adrenal Cushing syndrome. (A) Percentage of eosinophils in peripheral blood preoperative and postoperatively. (B) Preoperative and postoperative eosinophil count in peripheral blood.

  • Fig. 2 Serum and urine cortisol are inversely correlated with eosinophil numbers in the peripheral blood of patients with adrenal Cushing syndrome. Correlations between (A) 24-hour urine free cortisol and the percentage of eosinophils and (B) serum cortisol and the percentage of eosinophils. (C) Dexamethasone inhibited eosinophil survival at a concentration-dependent manner in vitro. Data are representative of three independent experiments and are expressed as mean±SD. aP<0.05; bP<0.01 in comparison with the corresponding controls.

  • Fig. 3 Impaired glucose metabolism in patients with adrenal Cushing syndrome is associated with the numbers of eosinophils in peripheral blood. (A) Fasting glucose levels are negatively correlated with the percentage of eosinophils. (B) Levels of glycated hemoglobin are negatively correlated with the percentage of eosinophils (C) Neutrophil-to-lymphocyte ratio is positively correlated with eosinophil population.

  • Fig. 4 Relationship between inflammation and the number of eosinophils in patients with adrenal Cushing syndrome. (A) The leukocyte count is negatively associated with the eosinophil count in patients with adrenal Cushing syndrome. (B) The neutrophil-to-lymphocyte ratio is negatively correlated with the eosinophil count in patients with adrenal Cushing syndrome.


Reference

1. Chanson P, Salenave S. Metabolic syndrome in Cushing's syndrome. Neuroendocrinology. 2010; 92(Suppl 1):96–101. PMID: 20829627.
Article
2. Di Somma C, Pivonello R, Loche S, Faggiano A, Marzullo P, Di Sarno A, et al. Severe impairment of bone mass and turnover in Cushing's disease: comparison between childhood-onset and adulthood-onset disease. Clin Endocrinol (Oxf). 2002; 56:153–158. PMID: 11874405.
Article
3. Pivonello R, De Leo M, Vitale P, Cozzolino A, Simeoli C, De Martino MC, et al. Pathophysiology of diabetes mellitus in Cushing's syndrome. Neuroendocrinology. 2010; 92(Suppl 1):77–81. PMID: 20829623.
Article
4. Vegiopoulos A, Herzig S. Glucocorticoids, metabolism and metabolic diseases. Mol Cell Endocrinol. 2007; 275:43–61. PMID: 17624658.
Article
5. Mazziotti G, Gazzaruso C, Giustina A. Diabetes in Cushing syndrome: basic and clinical aspects. Trends Endocrinol Metab. 2011; 22:499–506. PMID: 21993190.
Article
6. Bakker RC, Gallas PR, Romijn JA, Wiersinga WM. Cushing's syndrome complicated by multiple opportunistic infections. J Endocrinol Invest. 1998; 21:329–333. PMID: 9648056.
Article
7. Bronsart LL, Contag CH. A role of the adaptive immune system in glucose homeostasis. BMJ Open Diabetes Res Care. 2016; 4:e000136.
Article
8. Lackey DE, Olefsky JM. Regulation of metabolism by the innate immune system. Nat Rev Endocrinol. 2016; 12:15–28. PMID: 26553134.
Article
9. Wu D, Molofsky AB, Liang HE, Ricardo-Gonzalez RR, Jouihan HA, Bando JK, et al. Eosinophils sustain adipose alternatively activated macrophages associated with glucose homeostasis. Science. 2011; 332:243–247. PMID: 21436399.
Article
10. Zhu L, Su T, Xu M, Xu Y, Li M, Wang T, et al. Eosinophil inversely associates with type 2 diabetes and insulin resistance in Chinese adults. PLoS One. 2013; 8:e67613. PMID: 23894289.
Article
11. Ambrogio AG, De Martin M, Ascoli P, Cavagnini F, Pecori Giraldi F. Gender-dependent changes in haematological parameters in patients with Cushing’s disease before and after remission. Eur J Endocrinol. 2014; 170:393–400. PMID: 24362410.
Article
12. Greenblatt RB. Vagaries in the symptomatology of Cushing's syndrome. J Clin Endocrinol Metab. 1954; 14:961–968. PMID: 13183989.
Article
13. Kronfol Z, Starkman M, Schteingart DE, Singh V, Zhang Q, Hill E. Immune regulation in Cushing's syndrome: relationship to hypothalamic-pituitary-adrenal axis hormones. Psychoneuroendocrinology. 1996; 21:599–608. PMID: 9044443.
Article
14. Brode S, Farahi N, Cowburn AS, Juss JK, Condliffe AM, Chilvers ER. Interleukin-5 inhibits glucocorticoid-mediated apoptosis in human eosinophils. Thorax. 2010; 65:1116–1117. PMID: 20805156.
Article
15. Wallen N, Kita H, Weiler D, Gleich GJ. Glucocorticoids inhibit cytokine-mediated eosinophil survival. J Immunol. 1991; 147:3490–3495. PMID: 1940348.
16. Altman LC, Hill JS, Hairfield WM, Mullarkey MF. Effects of corticosteroids on eosinophil chemotaxis and adherence. J Clin Invest. 1981; 67:28–36. PMID: 7005265.
Article
17. Hallsworth MP, Litchfield TM, Lee TH. Glucocorticoids inhibit granulocyte-macrophage colony-stimulating factor-1 and interleukin-5 enhanced in vitro survival of human eosinophils. Immunology. 1992; 75:382–385. PMID: 1551701.
18. Geley S, Hartmann BL, Kapelari K, Egle A, Villunger A, Heidacher D, et al. The interleukin 1beta-converting enzyme inhibitor CrmA prevents Apo1/Fas- but not glucocorticoid-induced poly(ADP-ribose) polymerase cleavage and apoptosis in lymphoblastic leukemia cells. FEBS Lett. 1997; 402:36–40. PMID: 9013854.
19. Miyashita T, Mami U, Inoue T, Reed JC, Yamada M. Bcl-2 relieves the trans-repressive function of the glucocorticoid receptor and inhibits the activation of CPP32-like cysteine proteases. Biochem Biophys Res Commun. 1997; 233:781–787. PMID: 9168933.
Article
20. Suzukawa M, Koketsu R, Iikura M, Nakae S, Matsumoto K, Nagase H, et al. Interleukin-33 enhances adhesion, CD11b expression and survival in human eosinophils. Lab Invest. 2008; 88:1245–1253. PMID: 18762778.
Article
21. Cildir G, Akincilar SC, Tergaonkar V. Chronic adipose tissue inflammation: all immune cells on the stage. Trends Mol Med. 2013; 19:487–500. PMID: 23746697.
Article
22. Mraz M, Haluzik M. The role of adipose tissue immune cells in obesity and low-grade inflammation. J Endocrinol. 2014; 222:R113–R127. PMID: 25006217.
Article
23. Ricardo-Gonzalez RR, Red Eagle A, Odegaard JI, Jouihan H, Morel CR, Heredia JE, et al. IL-4/STAT6 immune axis regulates peripheral nutrient metabolism and insulin sensitivity. Proc Natl Acad Sci U S A. 2010; 107:22617–22622. PMID: 21149710.
Article
24. Stanya KJ, Jacobi D, Liu S, Bhargava P, Dai L, Gangl MR, et al. Direct control of hepatic glucose production by interleukin-13 in mice. J Clin Invest. 2013; 123:261–271. PMID: 23257358.
Article
25. Nittoh T, Fujimori H, Kozumi Y, Ishihara K, Mue S, Ohuchi K. Effects of glucocorticoids on apoptosis of infiltrated eosinophils and neutrophils in rats. Eur J Pharmacol. 1998; 354:73–81. PMID: 9726633.
Article
26. Nussbaum JC, Van Dyken SJ, von Moltke J, Cheng LE, Mohapatra A, Molofsky AB, et al. Type 2 innate lymphoid cells control eosinophil homeostasis. Nature. 2013; 502:245–248. PMID: 24037376.
Article
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