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Diabetes, Active Disease, and Afternoon Serum Cortisol Levels Predict Cushing's Disease Mortality: A Cohort Study

Paola Roldán-Sarmiento1, César Ernesto Lam-Chung1, José Miguel Hinojosa-Amaya1

  • 1Neuroendocrinology Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City, Mexico.

The Journal of Clinical Endocrinology and Metabolism
|October 27, 2020
PubMed

Insights

Cushing's disease patients face significantly higher mortality, primarily due to cardiovascular issues. Key risk factors include uncontrolled diabetes, high cortisol levels, and active disease, highlighting the need for vigilant management.

Area of Science:

  • Endocrinology
  • Oncology
  • Cardiovascular Medicine

Background:

  • Cushing's disease (CD) is a severe endocrine disorder linked to elevated mortality rates compared to the general population.
  • Understanding standardized mortality ratios (SMRs) and identifying mortality risk factors in CD patients is crucial for improving patient outcomes.

Observation:

  • A longitudinal cohort study from 1979-2018 analyzed 172 Cushing's disease patients.
  • The overall all-cause SMR was 3.1, with cardiovascular disease being the leading cause of death (SMR=4.2).
  • Eighteen patients (10.5%) died, with 44% of deaths occurring in those with active CD.

Findings:

  • Multivariate analysis revealed that diabetes (HR=5.2), high post-1600 cortisol levels (HR=3.4), and active CD (HR=7.5) were significant independent risk factors for mortality.
  • Diabetes, persistently high cortisol levels, and active disease at last follow-up were identified as primary mortality risks.

Implications:

  • These findings underscore the critical importance of managing comorbidities like diabetes and controlling cortisol levels in CD patients.
  • Effective management of active Cushing's disease is essential to reduce the elevated mortality risk, particularly from cardiovascular causes.
Abstract

Keywords:
corticotropindiabeteshypercortisolismstandardized mortality ratiosurvival

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