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Diagnostic dilemma in Cushing's syndrome: discrepancy between patient-reported and physician-assessed manifestations
Yuma Motomura1, Shin Urai1, Hironori Bando2
1Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, 650-0017, Japan.
Insights
Patients often do not report typical Cushing's syndrome (CS) symptoms, hindering early diagnosis. Physician assessment reveals more typical CS signs than patient complaints, highlighting a diagnostic gap.
Area of Science:
- Endocrinology
- Internal Medicine
Background:
- Early diagnosis and treatment of Cushing's syndrome (CS) are vital for improved patient outcomes.
- Discrepancies between patient-reported and physician-assessed symptoms may impede timely CS diagnosis.
Purpose of the Study:
- To investigate differences between patient-reported and physician-assessed manifestations in Cushing's syndrome.
- To identify how these discrepancies impact the early diagnosis of CS.
Main Methods:
- Retrospective analysis of 52 patients diagnosed with Cushing's syndrome.
- Independent review of patient-reported and physician-assessed typical and nonspecific CS features.
- Analysis of correlations and differences between reported and assessed manifestations.
Main Results:
- A positive correlation was found for nonspecific features but not typical features between patient and physician assessments.
- Physicians identified typical CS features more frequently than patients reported them.
- No significant differences were observed for most nonspecific features; typical feature concordance was not linked to cortisol levels.
Conclusions:
- Patients frequently do not report typical Cushing's syndrome manifestations crucial for diagnosis.
- This underreporting of key symptoms by patients can delay diagnosis, irrespective of disease severity.
Purpose:
Early diagnosis and immediate treatment of Cushing's syndrome (CS) are critical for a better prognosis but remain a challenge. However, few comprehensive reports have focused on this issue or investigated whether patient-reported manifestations are consistent with physician-assessed symptoms of CS. This study aimed to clarify the differences in patient-reported and physician-assessed manifestations of signs and symptoms of CS that prevent early diagnosis.
Methods:
This single-center retrospective study included 52 patients with CS (16 with Cushing's disease and 36 with adrenal CS). Upon clinical diagnosis, medical records were used to independently review the patient-reported and physician-assessed manifestations of typical (such as purple striae and proximal myopathy) and nonspecific features (such as hirsutism and hypertension). The correlations and differences between the patient-reported and physician-assessed manifestations were then analyzed.
Results:
We observed a positive correlation between the total number of manifestations of nonspecific features reported by patients and those assessed by physicians, but not for typical features. Moreover, manifestations reported by the patients were less frequent than those assessed by physicians for typical features, leading to discrepancies between the two groups. In contrast, there were no differences in most nonspecific features between the patient-reported and physician-assessed manifestations. Notably, the concordance between patient-reported and physician-assessed manifestations of typical features was not associated with urinary free cortisol levels.
Conclusion:
Regardless of disease severity, patients often do not complain of the typical features of CS that are crucial for formulating a diagnosis.
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