Endocrine https://doi.org/10.1007/s12020-018-1524-5 ORIGINAL ARTICLE Pasireotide treatment reduces cardiometabolic risk in Cushing’s disease patients: an Italian, multicenter study A. Albani 1 ● F. Ferraù 2 ● A. Ciresi 3 ● R. Pivonello 4 ● C. Scaroni 5 ● D. Iacuaniello 4 ● M. Zilio 5 ● V. Guarnotta 3 ● A. Alibrandi 6 ● E. Messina 7 ● M. Boscaro 5 ● C. Giordano 3 ● A. Colao 4 ● S. Cannavo 2,7 Received: 25 August 2017 / Accepted: 9 January 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Purpose Patients with Cushing’s disease (CD) experience metabolic alterations leading to increased cardiovascular mor- tality. Recently, the visceral adiposity index (VAI) has been proposed as a marker of visceral adipose tissue dysfunction (ATD) and of the related cardiometabolic risk. We aimed to evaluate the impact of 12-month pasireotide treatment on cardiometabolic risk in CD patients. Methods This is a multicentre, prospective, and observational study. Sixteen CD patients, referred to the Endocrine Units of the University Hospitals of Messina, Napoli, Padova, and Palermo (Italy), successfully treated with pasireotide for 12 month have been enrolled. In all patients, we assessed anthropometric, clinical, and biochemical parameters and calculated VAI, ATD severity, Framingham, and atherosclerotic cardiovascular disease (ASCVD) risk scores, before and after 6 and 12 months of treatment with pasireotide (1200–1800 mcg/daily). Results Before starting pasireotide treatment, ATD was present in 7/16 patients (mild in 2/16, moderate in 3/16, and severe 2/16). After 12 months of treatment: (i) 24h-urinary free cortisol levels (p = 0.003), BMI (p < 0.001), waist circumference (p = 0.001), LDL-cholesterol (p = 0.033), total-cholesterol (p = 0.032), triglycerides (p = 0.030), VAI (p = 0.015), and ATD severity (p = 0.026) were significantly decreased as compared to baseline; (ii) ATD was present in only 1/16 patients; (iii) prevalence of diabetes mellitus (p = 0.015) and HbA1c levels (p = 0.001) were significantly increased as compared to baseline; (iv) Framingham and ASCVD risk scores were not significantly different from pre-treatment values. Conclusions Twelve-month pasireotide treatment significantly reduces VAI and ATD in CD patients. These positive effects on cardiometabolic risk occur despite no change in Framingham and ASCVD risk scores and the increase in the prevalence of diabetes mellitus. Keywords Cushing’s disease ● Pasireotide ● Visceral adiposity index ● Cardiometabolic risk ● Hypercortisolism A. Albani and F. Ferraù contributed equally to this work. * F. Ferraù francesco.ferrau1@gmail.com 1 Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy 2 Department of Human Pathology of Adulthood and Childhood ‘G. Barresi’, University of Messina, Messina, Italy 3 Section of Endocrinology, Diabetology and Metabolism, DIBIMIS, University of Palermo, Palermo, Italy 4 Department of Clinical Medicine and Surgery, Endocrinology Unit, University of Naples Federico II, Naples, Italy 5 Department of Medicine (DIMED), Endocrinology Unit, University-Hospital of Padua, Padova, Italy 6 Department of Economics, University of Messina, Messina, Italy 7 Unit of Endocrinology, University Hospital ‘G. Martino’, Messina, Italy 1234567890();,: