Evidence map›Paper›PMID 42274271›Full record

ReviewJournal of neuroendocrinology2026

The aging paradox of Cushing's syndrome: Stress without clear senescence?

Israel Nunes Silveira, Alexandro Guterres

Abstract readReview
In one paragraph

Review in Journal of neuroendocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

2 authors.

Israel Nunes SilveiraDepartment of Genetics, Ribeirão Preto Medical School, University of São Paulo - USP, São Paulo, Brazil.
Alexandro GuterresDepartment of Genetics, Ribeirão Preto Medical School, University of São Paulo - USP, São Paulo, Brazil.ORCID https://orcid.org/0000-0001-8323-1477

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Cushing's syndrome (CS), characterized by chronic endogenous hypercortisolism and disruption of the normal circadian cortisol rhythm, represents a unique human model for investigating the interplay between stress endocrinology and biological aging. Glucocorticoid excess drives multiple convergent aging pathways: it suppresses telomerase activity and may accelerate telomere attrition, induces durable epigenetic remodeling, including hypomethylation of stress-responsive genes such as FKBP5, TET-mediated DNA hydroxymethylation changes, and broad dysregulation of circadian clock loci, and promotes telomere-independent senescence through mitochondrial dysfunction, oxidative stress, and cytokine-driven inflammation. These observations underpin a proposed dual-pathway model of glucocorticoid-accelerated aging, in which direct telomerase suppression and indirect epigenomic remodeling converge on common hallmarks of cellular senescence. However, clinical evidence remains heterogeneous and inconclusive: studies of leukocyte telomere length in CS report discrepant results attributable to assay platform differences, failure to correct for glucocorticoid-induced lymphopenia, small sample sizes, and predominant reliance on cross-sectional designs. Epigenetic clocks capable of quantifying biological age acceleration, particularly second-generation tools such as GrimAge and DunedinPACE, have not yet been applied to CS cohorts, representing a critical evidence gap. Furthermore, virtually all molecular aging measurements in CS have been performed in peripheral blood, leaving the causal chain from glucocorticoid excess to organ-level aging and excess mortality empirically unproven. Rather than a definitive null result, this paradox reveals that CS is an underexplored natural experiment: the syndrome's defined onset, quantifiable cortisol exposure, and surgically curable course offer a unique before-after design for testing whether stress-induced endocrine disruption genuinely accelerates biological aging through telomere and epigenetic mechanisms.

Indexed as

AgingCushing SyndromeStress, PhysiologicalAnimalsCellular SenescenceEpigenesis, GeneticHumansbiological agingCushing's syndromeepigenetic aginghypercortisolismtelomere dynamics

Identifiers

PMID42274271
PMCPMC13255748

What Socratic holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.