Cushing syndrome of different etiologies - cardiometabolic complications, venous thromboembolic events and mortality:
Mari Minasyan1, Aleksandra Gamrat-Żmuda1, Agata Bryk-Wiązania1
1Chair and Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland.
Insights
Cushing syndrome (CS) patients exhibit significant comorbidities and high mortality, particularly in the ectopic CS group. This study highlights the critical need for effective CS management strategies to improve patient outcomes.
Area of Science:
- Endocrinology
- Internal Medicine
- Clinical Research
Background:
- Cushing syndrome (CS) is a condition of prolonged cortisol excess, leading to severe health complications and increased mortality.
- Understanding the diverse clinical presentations and outcomes of CS is crucial for effective patient management.
Purpose of the Study:
- To analyze the etiology, demographics, comorbidities, thromboembolic events, and mortality in a cohort of 214 Cushing syndrome patients.
- To compare clinical characteristics and outcomes across different subtypes of CS: pituitary, adrenal, and ectopic.
Main Methods:
- Retrospective analysis of 214 consecutive CS patients from a single tertiary endocrinology center in Poland.
- Data collected included etiology, demographics, cardiometabolic comorbidities, venous thromboembolic events, and mortality.
- Statistical analysis performed using Statistica 13.0, with significance set at p ≤0.05.
Main Results:
- Pituitary CS predominated (53%), followed by adrenal (25%) and ectopic (22%).
- Hypertension, dyslipidemia, and glucose metabolism impairments were highly prevalent across all CS types.
- Ectopic CS showed higher prevalence of ischemic heart disease, heart failure, and significantly higher mortality (62%) compared to pituitary and adrenal CS.
Conclusions:
- Cushing syndrome patients present with substantial comorbidities and a high mortality rate.
- Mortality was notably higher in males and the ectopic CS group, with tumor progression and infections being primary causes of death.
- Findings underscore the need for tailored management strategies for different CS subtypes to mitigate complications and improve survival.
Introduction:
Cushing syndrome (CS) as a state of prolonged cortisol excess is associated with multiple complications that contribute to increased mortality in affected patients.
Materials And Methodology:
This retrospective study presents data on etiology, demographic features, baseline cardiometabolic comorbidities, venous thromboembolic events and mortality of 214 consecutive CS patients from a single tertiary endocrinology center in Poland, a part of the European Register on Cushing's Syndrome (ERCUSYN). The group was predominated by pituitary CS (53%, PIT-CS), followed by adrenal CS (25%, ADR-CS) and ectopic CS (22%, ECT-CS). Statistica 13.0 was used to perform data analysis. Statistical significance was settled for a p-value ≤0.05.
Results:
The PIT-CS group was significantly younger than others. The PIT-CS and ADR-CS groups were predominated by women, contrary to the ECT-CS group, predominated by men. At the baseline, respectively 80%, 78%, and 66% of patients presented hypertension, dyslipidemia, and glucose metabolism impairments. Ischemic heart disease and heart failure were significantly more prevalent among ECT-CS. Venous thromboembolic events were present among 6% of patients. Overall mortality rate was 18%, and was higher in males than females (30% vs 15%; p<0.05), and was the highest in ECT-CS group (62%). The most common cause of death was tumor progression (55%) and infectious disease (26%).
Conclusions:
CS patients from our study presented a high number of comorbidities and high mortality rate. Some of the results were convergent with reports of the entire ERCUSYN database and other studies, while other results differed from the data reported in the literature.
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