Mortality and morbidity in Cushing’s syndrome in New Zealand

Bolland, Mark J; Holdaway, I. M.; Berkeley, Juliet E.; Lim, Sarina; Dransfield, Will J.; Conaglen, John V.; Croxson, Michael; Gamble, Greg; Hunt, P. S.; Toomath, Robyn

doi:10.1111/j.1365-2265.2011.04124.x

Cited by 166 publications

(175 citation statements)

References 14 publications

(56 reference statements)

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“…The median of 2 years from symptom-onset to diagnosis found in our study is identical to that reported in a recent study from the European Registry on Cushing's Syndrome (ERCUSYN) (6) and another retrospective study on CS by Bolland et al (5), but in these studies symptomonset was rated by physicians on the basis of chart records. The fact that more than half of the patients of this study were diagnosed within 1 year from first physician contact (median of 1 year from first doctor visit to diagnosis) speaks for an improved awareness of this disease entity within the last years.…”

Section: European Journal Of Endocrinologysupporting

confidence: 78%

“…The diagnostic latency of Cushing's syndrome (CS) in general is reported with a median of 2 years in two recent studies, but studies which focus exclusively on the latency between symptom occurrence and diagnosis of pituitary-dependent CD are lacking so far (5,6). Also, no data exist which elucidate the reasons for the long diagnostic process of patients with CD or CS.…”

Section: Introductionmentioning

confidence: 99%

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From first symptoms to final diagnosis of Cushing's disease: experiences of 176 patients

Kreitschmann-Andermahr¹,

Psaras²,

Tsiogka³

et al. 2015

European Journal of Endocrinology

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Objective: To obtain structured information on the diagnostic delay in patients with Cushing's disease (CD) from the patients perspective to provide leverage points for earlier diagnosis. Design: The study includes 176 patients with ACTH-dependent CD who had received pituitary surgery completed a self-developed questionnaire on their symptomatology before the illness was diagnosed, the course and length of the diagnostic process, and the role of the involved health care professionals. Methods: Data were analyzed statistically. Answers in free text options were categorized and counted. Results: The overall diagnostic process took 3.8G4.8 years (median 2 years), during which 4.6G3.8 (1-30) physicians were consulted, most frequently the family physician (FP; 83.0%). The presented symptoms were various and often vague, e.g. 'poor general condition' (at FPs), or very common in the field of the visited specialist (i.e. 'skin changes' at dermatologists). Women recognized the first CD symptoms themselves significantly more frequently than men, whereas physicians recognized CD symptoms significantly more frequently in males. Conclusion: A clear difficulty of diagnosing CD seems that patients describe isolated symptoms to the FP or the respective specialists according to their fields of specialization. As FPs are contacted most frequently, they should be trained to recognize the broad spectrum of CD symptoms, especially in female patients with weight gain, and initiate endocrinological referral.

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Section: European Journal Of Endocrinologysupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

From first symptoms to final diagnosis of Cushing's disease: experiences of 176 patients

Kreitschmann-Andermahr¹,

Psaras²,

Tsiogka³

et al. 2015

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…SMR was shown to be increased to 3.73 in patients with persistent Cushing's disease after transsphenoidal surgery (22). Furthermore, persistently increased mortality had been reported even after long-term biochemical remission (23,24). In a recent study, cardiovascular risk was found to be persistent despite dramatic improvements in body composition abnormalities (25).…”

Section: Discussionmentioning

confidence: 97%

“…bolus of 250 mg synthetic ACTH (Synacthen 0.25 mg/ml; Novartis Healthcare) at 0800 h. Venous blood was drawn through an indwelling catheter at 0, 30, and 60 min after ACTH administration for the determination of 17-OHP and 11-S. On the luteal phase of the cycle (menstrual days [22][23][24], progesterone was measured.…”

Section: Materials and Protocolsmentioning

confidence: 99%

Routine screening for Cushing's syndrome is not required in patients presenting with hirsutism

Karaca

Acmaz

Açmaz

et al. 2013

European Journal of Endocrinology

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Context: Prevalence of Cushing's syndrome (CS) in patients presenting with hirsutism is not well known. Objective: Screening of CS in patients with hirsutism. Setting: Referral hospital. Patients and other participants: This study was carried out on 105 patients who were admitted to the Endocrinology Department with the complaint of hirsutism. Intervention: All the patients were evaluated with low-dose dexamethasone suppression test (LDDST) for CS. Main outcome measure: Response to LDDST in patients presenting with hirsutism. Results: All the patients had suppressed cortisol levels following low-dose dexamethasone administration excluding CS. The etiology of hirsutism was polycystic ovary syndrome in 79%, idiopathic hirsutism in 13%, idiopathic hyperandrogenemia in 6%, and nonclassical congenital hyperplasia in 2% of the patients. Conclusion: Routine screening for CS in patients with a referral diagnosis of hirsutism is not required. For the time being, diagnostic tests for CS in hirsute patients should be limited to patients who have accompanying clinical stigmata of hypercortisolism.

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“…The fact that the diagnosis of Cushing's syndrome is often delayed by several years (1,2) is not surprising, given that the early features are characteristically non-specific. However, detection in this pre-clinical phase offers the theoretical potential to prevent Cushing's syndrome or reduce cortisol levels, which may otherwise act to accelerate cardiovascular disease (through blood pressure, lipids, and dysglycaemia) and ageing (through atrophic effects on skin, muscle and bone) and also have adverse neurocognitive effects.…”

mentioning

confidence: 99%

Screening for ACTH-dependent hypercortisolism in patients with pituitary incidentaloma

Torpy

2015

European Journal of Endocrinology

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Mortality and morbidity in Cushing’s syndrome in New Zealand

Abstract: CS is associated with both high mortality and a high prevalence of co-morbidities, even when biochemical cure rates are between 80% and 90%.

Cited by 166 publications

References 14 publications

From first symptoms to final diagnosis of Cushing's disease: experiences of 176 patients

From first symptoms to final diagnosis of Cushing's disease: experiences of 176 patients

Routine screening for Cushing's syndrome is not required in patients presenting with hirsutism

Screening for ACTH-dependent hypercortisolism in patients with pituitary incidentaloma

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