Low work ability and high disability burden in Cushing's syndrome: a multicenter cohort study

The socio-occupational burden of Cushing's syndrome (CS) remains underrecognised. In clinical practice, surgically treated patients are often considered recovered, potentially overlooking persistent impairment.

To evaluate work ability, social and employment status in newly diagnosed and remitted CS.

National observational study with two arms: a monocentric prospective study of patients evaluated for suspected endogenous glucocorticoid excess (cohort 1), and a multicenter cross-sectional study of patients in remission from CS, comparing those with recovered versus persistent adrenal insufficiency (cohort 2). All participants underwent standardised assessments and completed validated questionnaires on socioeconomic status, work ability, and fatigue.

In cohort 1, individuals with active CS (n = 28) and excluded CS (n = 56) had comparable comorbidities, education, and employment. However, work ability scores were lower in active CS (median 22.5 vs. 28.5, p = 0.008) and correlated inversely with biochemical cortisol excess. In multivariable analyses, active CS and depression were independently associated with lower work ability, whereas older age and depression were independently associated with fatigue severity. In cohort 2 (n = 89, 39 with recovered, 50 with persistent adrenal insufficiency), overall employment was 69%. Poor work ability was common (42% with recovered vs. 58% with persistent adrenal insufficiency) and weekly working hours were lower in those with persistent insufficiency (33 h vs. 39 h, p = 0.051). Overall, illness-related absences occurred in 76% during the preceding year, disability was recognised in 47%, and 15% received reduced earning capacity pensions. Fatigue correlated negatively with work ability (r = - 0.73, p < 0.0001).

There is an unmet need for structured rehabilitation and reintegration in CS.