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Risk of infection-related hospitalization is more than doubled in Cushing's syndrome vs matched controls
Amit Akirov1, Alaa Atamna2, Yaron Rudman1
1Gray Faculty of Medical & Health Sciences, Tel Aviv University, Israel; Institute of Endocrinology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
The American Journal of Medicine
|June 24, 2026
Summary
Patients with Cushing's syndrome face a significantly higher risk of hospitalization due to infections, including common and opportunistic types. This increased infection risk persists even after the condition is in remission, highlighting the need for ongoing monitoring.
Area of Science:
- Endocrinology
- Infectious Diseases
- Public Health
Background:
- Cushing's syndrome is known to cause immune dysfunction, increasing infection susceptibility.
- The specific risk of infection-related hospitalization in Cushing's syndrome patients is not well-established.
Purpose of the Study:
- To evaluate and quantify the risk of infection-related hospitalization in patients with Cushing's syndrome compared to a control group.
- To analyze infection risk based on Cushing's syndrome etiology, remission status, and infection type.
Main Methods:
- A cohort study using the Clalit Health Services database.
- 609 patients with Cushing's syndrome were matched with 3,018 controls based on age, sex, socioeconomic status, and BMI.
- Competing-risk models were employed to analyze infection-related hospitalizations, with death as a competing event.
Main Results:
- Patients with Cushing's syndrome had a 2.5-fold higher risk of infection-related hospitalization (HR 2.5).
- Increased risk was observed for both Cushing's disease (HR 3.8) and adrenal Cushing's (HR 2.3).
- Respiratory and genitourinary infections were most common; opportunistic infections were more frequent in Cushing's patients (12.5% vs 5.6%). Risk persisted post-remission.
Conclusions:
- Cushing's syndrome significantly increases the risk of hospitalization for both common and opportunistic infections.
- This elevated risk remains even after achieving remission, underscoring the long-term impact of the syndrome.
- Findings support the need for continuous infection surveillance and proactive preventive strategies in Cushing's syndrome management.
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