Glucocorticoid-Induced Positive Feedback in Cushing Disease: Insights From a Spanish Multicenter Cohort
Authors' conclusion
GIPF occurs in up to 9% of patients with CD and is associated with poorer surgical outcomes and lower remission rates. This phenotype likely represents a distinct subtype of corticotroph adenoma, highlighting the need for closer follow-up and molecular characterization.
Study context
- Population
- Patients with cushing disease (CD) who had a complete overnight 1-mg dexamethasone suppression test, SPAIN-CUSHING registry
- Participants
- 139 patients
- Exposure
- Glucocorticoid-induced positive feedback (GIPF) vs no GIPF
- GIPFn = 13
- Outcome
- Prevalence of GIPF
Methodological detailsmulticenter, SPAIN-CUSHING registry
- Multicenter
- SPAIN-CUSHING registry
Main finding
As reported in the abstract
GIPF
9.3%
13
Observational data: associations, not effects.
Further findings
| Outcome | GIPF | P value |
|---|---|---|
| BMILower with GIPF | 26.4 kg/m² | P = 0.032 |
| UFC (ratio to upper limit of normal)Higher with GIPF | 4.7 upper limit of normal | P = 0.047 |
| ACTH response to desmopressinMarkedly greater with GIPF | 525.0 pg/mL | P = 0.022 |
| Remission after surgerySignificantly lower with GIPF | 28.6% | P = 0.036 |
- Recurrence-free survival after transsphenoidal surgery · reduced with GIPF (Kaplan-Meier)
- log-rank P = .04
Tumour size, macroadenomas, cavernous sinus invasion
- Tumor size, proportion of macroadenomas, and cavernous sinus invasion did not differ
Clinical phenotypes and comorbidities
- Clinical phenotypes and comorbidities were otherwise similar
Original publication
Glucocorticoid-Induced Positive Feedback in Cushing Disease: Insights From a Spanish Multicenter Cohort. Endocr Pract. Published 22 December 2025. doi:10.
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