Cushing's disease in older patients: Presentation and outcome

Qiao, Na; Swearingen, Brooke; Tritos, Nicholas A.

doi:10.1111/cen.13799

Cited by 11 publications

(15 citation statements)

References 45 publications

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“…Our data also showed that aging attenuates the well-known female preponderance in the prevalence of PIT-CS observed in adult population (14,16). In fact, slightly more than half of the elderly patients were females, whereas women represented almost three-quarters of the younger patients.…”

Section: Discussionsupporting

confidence: 74%

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Cushing's syndrome in the elderly: data from the European Registry on Cushing's syndrome

Amodru

Ferrière

Tabarin

et al. 2023

European Journal of Endocrinology

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Objective To evaluate whether age-related differences exist in clinical characteristics, diagnostic approach and management strategies in patients with Cushing’s syndrome included in the European Registry on Cushing’s Syndrome (ERCUSYN). Design Cohort study. Methods We analyzed 1791 patients with CS, of whom 1234 (69%) had pituitary-dependent CS (PIT-CS), 450 (25%) adrenal-dependent CS (ADR-CS) and 107 (6%) had an ectopic source (ECT-CS). According to the WHO criteria, 1616 patients (90.2%) were classified as younger (<65 years) and 175 (9.8%) as older (>65 years). Results Older patients were more frequently males and had a lower BMI and waist circumference as compared with the younger. Older patients also had a lower prevalence of skin alterations, depression, hair loss, hirsutism and reduced libido, but a higher prevalence of muscle weakness, diabetes, hypertension, cardiovascular disease, venous thromboembolism and bone fractures than younger patients, regardless of sex (p<0.01 for all comparisons). Measurement of UFC supported the diagnosis of CS less frequently in older patients as compared with the younger (p<0.05). An extra-sellar macroadenoma (macrocorticotropinoma with extrasellar extension) was more common in older PIT-CS patients than in the younger (p<0.01). Older PIT-CS patients more frequently received cortisol-lowering medications and radiotherapy as a first-line treatment, whereas surgery was the preferred approach in the younger (p<0.01 for all comparisons). When transsphenoidal surgery was performed, the remission rate was lower in the elderly as compared with their younger counterpart (p<0.05). Conclusions Older CS patients lack several typical symptoms of hypercortisolism, present with more comorbidities regardless of sex, and are more often conservatively treated.

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Section: Discussionsupporting

confidence: 74%

“…Conversely, in a recent study, Qiao et al showed that 45 CD patients older than 60 more commonly presented with a catabolic phenotype and cardiometabolic comorbidities as compared with younger patients (14).…”

Section: Significance Statementmentioning

confidence: 89%

Cushing's syndrome in the elderly: data from the European Registry on Cushing's syndrome

Amodru

Ferrière

Tabarin

et al. 2023

European Journal of Endocrinology

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“…Older patients with CD appear to have a distinct phenotype with a highly catabolic nature, including lower BMI and greater prevalence of muscle wasting [52]. A number of comorbidities tend to be more common in older patients than in younger patients, including hypertension, diabetes mellitus, history of cardiovascular disease, and history of deep vein thrombosis.…”

Section: Clinical Featuresmentioning

confidence: 99%

Cushing’s Disease

Nishioka

Yamada²

2019

JCM

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In patients with Cushing’s disease (CD), prompt diagnosis and treatment are essential for favorable long-term outcomes, although this remains a challenging task. The differential diagnosis of CD is still difficult in some patients, even with an organized stepwise diagnostic approach. Moreover, despite the use of high-resolution magnetic resonance imaging (MRI) combined with advanced fine sequences, some tumors remain invisible. Surgery, using various surgical approaches for safe maximum tumor removal, still remains the first-line treatment for most patients with CD. Persistent or recurrent CD after unsuccessful surgery requires further treatment, including repeat surgery, medical therapy, radiotherapy, or sometimes, bilateral adrenalectomy. These treatments have their own advantages and disadvantages. However, the most important thing is that this complex disease should be managed by a multidisciplinary team with collaborating experts. In addition, a personalized and individual-based approach is paramount to achieve high success rates while minimizing the occurrence of adverse events and improving the patients’ quality of life. Finally, the recent new insights into the pathophysiology of CD at the molecular level are highly anticipated to lead to the introduction of more accurate diagnostic tests and efficacious therapies for this devastating disease in the near future.

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“…On the contrary, in a study by Qiao at al. including 45 patients with CD older than 60 years and 90 patients below this age, no age-related differences in adenoma size were reported [10]. Aging appears to also attenuate the typical female preponderance in the prevalence of pituitary CS, in that slightly more than a half of the elderly patients were females in the ERCUSYN population, whereas women represented almost three-quarters of the younger patients [9].…”

mentioning

confidence: 92%

Cushing's Syndrome in the Elderly

Zdrojowy-Wełna,

Valassi

2024

Exp Clin Endocrinol Diabetes

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Management of Cushing’s syndrome (CS) can be particularly challenging in older patients, due to the lack of several clinical features associated with cortisol excess along with a greater burden of comorbidities in them, as compared with the younger. Moreover, interpretation of diagnostic tests could be influenced by age-related physiological changes of cortisol secretion. While mortality is higher and quality of life is more impaired in the elderly with CS as compared with the younger, there is currently no agreement on the most effective therapeutic options in aged individuals, and safety data concerning medical treatment are scanty. In this review, we summarize the current knowledge about age-related differences in etiology, clinical presentation, treatment and outcomes of CS, and describe the potential underlying mechanisms.

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Cushing's disease in older patients: Presentation and outcome

Abstract: Older patients with CD appear to have a distinct phenotype with a more catabolic picture, including a lower BMI and greater prevalence of muscle wasting. Surgical outcomes are similar without a significant age-related increase in complications.

Cited by 11 publications

References 45 publications

Cushing's syndrome in the elderly: data from the European Registry on Cushing's syndrome

Cushing's syndrome in the elderly: data from the European Registry on Cushing's syndrome

Cushing’s Disease

Cushing's Syndrome in the Elderly

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