Ocular Hypertension Risk Elevated in Patients With Cushing Disease

Endogenous hypercortisolemia should be considered part of the glaucoma assessment.

Cushing disease (CD) can elevate the risk for ocular hypertension, according to a study published in the Journal of Glaucoma. CD is characterized by hypercortisolism resulting from a corticotroph pituitary adenoma that secretes excessive adrenocorticotrophic hormone (ACTH). Researchers suggest that endogenous hypercortisolemia should be considered part of the glaucoma assessment. 

This prospective analysis was conducted at a large pituitary center in China. The researchers looked at 52 patients (mean age, 38.4±12.4 years; 41 women) admitted for surgery between January and July 2019. Postoperative intraocular pressure (IOP) and visual field (VF) tests took place after 1 and 3 months. Individuals with acromegaly (mean age, 47.3±12.6; 20 women) or NFPA (mean age, 49.3±13.7; 21 women) were placed into control groups randomly.

The CD cohort had the highest IOPS, with averages of 20.0±7.1 mm Hg in their right eyes and 19.4±5.4 mm Hg in the left. Participants with acromegaly had average readings of 18.6±7.0 mm Hg in the right eyes and 17.5±2.3 mm Hg in the left. In the NFPA group, averages were 17.4±2.4 mm Hg in the right eye and17.8±2.6 mm Hg in the left eye. Notably, 20.2% of CD eyes received diagnoses of ocular hypertension, compared with 4.7% affected by acromegaly, and 4.5% of eyes with NFPA. Glaucomatous VF damage occurred only in the CD group, affecting 6.7% of these eyes.

Investigators examined risks for ocular hypertension in individuals with CD; including age, comorbidities, and other variables. Only 24-hour urine-free cortisol (UFC) level was significantly associated to ocular hypertension (P =.025). Further, participants with more than 3 times greater than the normal UFC high cut-off were more at risk for ocular hypertension, OR 19.4 (95% CI, 1.7 to 72.6) than individuals with a lower UFC.

The results of this study can inform ophthalmologists and neuroendocrinologists that in patients with ocular hypertension and glaucoma, endogenous hypercortisolemia should be considered.

Of patients with CD, 94.3% attained remission following tumor resection — IOP decreased at 1 month, right 16.9±4.8 mm Hg and left 16.9±4.3 mm Hg; remaining stable at 3 months. Six of 7 eyes exhibiting VF change improved in follow-up tests. Individuals with acromegaly showed relatively constant IOP from before surgery until 3 months afterwards. 

Previous studies have considered elevated IOP in those with CD: 7 in a cohort of 22 exhibited raised serum cortisol levels and IOP, though this relationship did not prove statistically significant; in a case study, a patient’s high pressure returned to normal at the 1-year follow-up; and research with 62 participants revealed 4 eyes displaying higher IOP prior to surgery — but these papers did not address RNFL changes, the study noted. Present investigators found no significant intergroup differences in peripapillary RNFL thickness, although the study period was short.

“The results of this study can inform ophthalmologists and neuroendocrinologists that in patients with ocular hypertension and glaucoma, endogenous hypercortisolemia should be considered,” the researchers explain. 

Limitations of this investigation include only one category of Cushing’s syndrome, use of a non-contact tonometer, no corneal thickness analysis, only one clinical examiner, and no supplementation of ocular assessments with optic disc description.

References:

Ma Y, Chen Z, Ma Z, Ye H, et al. Increased risk of ocular hypertension in patients with Cushing’s disease. J Glaucoma. 2022;31(12):941-946. doi: 10.1097/IJG.0000000000002113