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Open Access 26-07-2023

Complications and mortality of Cushing’s disease: report on data collected over a 20-year period at a referral centre

Authors: Alessandro Mondin, Filippo Ceccato, Giacomo Voltan, Pierluigi Mazzeo, Renzo Manara, Luca Denaro, Carla Scaroni, Mattia Barbot

Published in: Pituitary | Issue 5/2023

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Abstract

Context

Cushing’s disease (CD) is rare condition burdened by several systemic complications correlated to higher mortality rates. The primary goal of clinicians is to achieve remission, but it is unclear if treatment can also increase life expectancy.

Aim

To assess the prevalence of cortisol-related complications and mortality in a large cohort of CD patients attending a single referral centre.

Materials and methods

The clinical charts of CD patients attending a referral hospital between 2001 and 2021 were reviewed.

Results

126 CD patients (median age at diagnosis 39 years) were included. At the last examination, 78/126 (61.9%) of the patients were in remission regardless of previous treatment strategies. Patients in remission showed a significant improvement in all the cardiovascular (CV) comorbidities (p < 0.05). The CV events were more frequent in older patients (p = 0.003), smokers and persistent CD groups (p < 0.05). Most of the thromboembolic (TE) and infective events occurred during active stages of the disease. The CV events were the most frequent cause of death. The standardized mortality ratio (SMR) resulted increased in persistent cases at the last follow-up (SMR 4.99, 95%CI [2.15; 9.83], p < 0.001) whilst it was not higher in those in remission (SMR 1.66, 95%CI [0.34; 4.85], p = 0.543) regardless of the timing or number of treatments carried out. A younger age at diagnosis (p = 0.005), a microadenoma (p = 0.002), and remission status at the last follow-up (p = 0.027) all increased survival. Furthermore, an elevated number of comorbidities, in particular arterial hypertension, increased mortality rates.

Conclusions

Patients with active CD presented a poor survival outcome. Remission restored the patients’ life expectancy regardless of the timing or the types of treatments used to achieve it. Persistent CD-related comorbidities remained major risk factors.
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Metadata
Title
Complications and mortality of Cushing’s disease: report on data collected over a 20-year period at a referral centre
Authors
Alessandro Mondin
Filippo Ceccato
Giacomo Voltan
Pierluigi Mazzeo
Renzo Manara
Luca Denaro
Carla Scaroni
Mattia Barbot
Publication date
26-07-2023
Publisher
Springer US
Published in
Pituitary / Issue 5/2023
Print ISSN: 1386-341X
Electronic ISSN: 1573-7403
DOI
https://doi.org/10.1007/s11102-023-01343-2

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