{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T22:25:14Z","timestamp":1793053514555,"version":"4.5.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"3","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,9,1]]},"abstract":"<jats:sec>\n<jats:title>Objective<\/jats:title>\n<jats:p>Endogenous hypercortisolism predisposes to impaired immune function and infections. To date, however, it is unknown whether there is a subtype-specific pattern in white blood cell (WBC) and WBC differential (WBCD) count.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A retrospective monocentric cohort study was carried out in patients with overt endogenous Cushing\u2019s syndrome (CS) or adrenal incidentalomas and autonomous cortisol secretion (ACS), with WBC\/WBCD analysis at initial diagnosis and after biochemical remission. Cut-offs were obtained by receiver-operating characteristics analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>In total, 253 patients were analyzed (Cushing\u2019s disease (CD); <jats:italic>n<\/jats:italic>\u2009\u2009=\u200988; ectopic CS (ECS), <jats:italic>n<\/jats:italic>\u2009\u2009=\u200931; cortisol-producing adrenal adenomas (CPA), <jats:italic>n<\/jats:italic>\u2009\u2009=\u200940; ACS, <jats:italic>n<\/jats:italic>\u2009\u2009=\u200945; adrenocortical carcinomas (ACC), <jats:italic>n<\/jats:italic>\u2009\u2009=\u200949). Total leukocytes and neutrophils correlated positively with serum cortisol after 1-mg dexamethasone (r\u2009=\u20090.314 and r\u2009=\u20090.428), while a negative correlation was observed for lymphocytes and eosinophils (r\u2009=\u2009\u22120.374 and r= \u22120.380) (each <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001). Similar observations were made for 24 h-urinary free cortisol. CD and ECS differed in numbers of neutrophils and lymphocytes (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001) and were well differentiated at a cut-off of 6.1 for the neutrophil\/lymphocyte ratio (sensitivity 90.0%, specificity 89.4%, and areas under the curve (AUC) 0.918). For adrenocorticotropic hormone (ACTH)-independent CS, the best diagnostic outcome was obtained for the discrimination of CPA and ACC at a cut-off of 187.9 for the platelet\/lymphocyte ratio (sensitivity 59.6%, specificity 80.6%, and AUC 0.713). For ECS, CPA, and CD, neutrophils decreased (delta \u221247.0, \u221229.7, and \u221226.2%) and lymphocytes increased (+123.2, +78.1, and +17.7%) already 3 months after remission.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Most immune cells correlate with the degree of hypercortisolism and differ among CS subtypes. WBCD changes are already identified 3 months after remission from endogenous hypercortisolism.<\/jats:p>\n<\/jats:sec>","DOI":"10.1530\/eje-22-0211","type":"journal-article","created":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T17:37:34Z","timestamp":1657129054000},"page":"439-449","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-7","source":"Crossref","is-referenced-by-count":25,"title":["Subtype-specific pattern of white blood cell differential in endogenous hypercortisolism"],"prefix":"10.1093","volume":"187","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1490-5575","authenticated-orcid":true,"given":"Mario","family":"Detomas","sequence":"first","affiliation":[{"name":"Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of W\u00fcrzburg, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Altieri","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of W\u00fcrzburg, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6741-2689","authenticated-orcid":true,"given":"Irina","family":"Chifu","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of W\u00fcrzburg, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Remde","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of W\u00fcrzburg, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Division of Hematology, Department of Internal Medicine II, University Hospital W\u00fcrzburg, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura-Sophie","family":"Landwehr","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of W\u00fcrzburg, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6271-5533","authenticated-orcid":true,"given":"Silviu","family":"Sbiera","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of W\u00fcrzburg, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7628-3161","authenticated-orcid":true,"given":"Matthias","family":"Kroiss","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of W\u00fcrzburg, W\u00fcrzburg, Germany"},{"name":"Medizinische Klinik und Poliklinik IV, Klinikum der Universit\u00e4t M\u00fcnchen, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6170-6398","authenticated-orcid":true,"given":"Martin","family":"Fassnacht","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of W\u00fcrzburg, W\u00fcrzburg, Germany"},{"name":"Central Laboratory, University Hospital W\u00fcrzburg, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"Deutschbein","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of W\u00fcrzburg, W\u00fcrzburg, Germany"},{"name":"Medicover Oldenburg MVZ, Oldenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","reference":[{"key":"bib1","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1016\/S0140-6736(14)61375-1","article-title":"Cushing\u2019s syndrome","volume":"386","author":"Lacroix","year":"2015","unstructured":"Lacroix AFeelders RAStratakis CANieman LK. 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