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Surviving ectopic Cushing's syndrome: Quality of life, cardiovascular and metabolic outcomes in comparison to Cushing's disease during long-term follow-up


Osswald, Andrea; Deutschbein, Timo; Berr, Christina Maria; Plomer, Eva; Mickisch, Anne; Ritzel, Katrin; Schopohl, Jochen; Beuschlein, Felix; Fassnacht, Martin; Hahner, Stefanie; Reincke, Martin (2018). Surviving ectopic Cushing's syndrome: Quality of life, cardiovascular and metabolic outcomes in comparison to Cushing's disease during long-term follow-up. European Journal of Endocrinology, 179(2):109-116.

Abstract

OBJECTIVE Aim of our study was to analyze long-term outcome of patients with the ectopic Cushing's syndrome (ECS) compared to patients with Cushing's disease (CD) regarding cardiovascular, metabolic, musculoskeletal and psychiatric co-morbidities. DESIGN Cross-sectional study in patients with ECS and CD in two German academic tertiary-care centers. METHODS Standardized clinical follow-up examination was performed including health-related quality of life (QoL) in 21 ECS patients in long-term remission (≥ 18 months since successful surgery). 59 patients with CD in remission served as controls. RESULTS Time from first symptoms to diagnosis of CS was shorter in ECS than in CD (8.5 (IQR 30.3) vs. 25 (IQR 39.0) months, p=0.050). ECS patients had lower self-reported psychiatric morbidity compared to CD (19% vs. 43%, p=0.050) at follow-up. Moreover, female ECS patients reported favorable scores for QoL in the SF-36 questionnaire (mental health: 92 (IQR 30) vs. 64 (IQR 32) in CD, p=0.010) and a Cushing-specific QoL-questionnaire (73 (IQR 18) vs. 59 (IQR 36) in CD, p=0.030). In a pooled analysis of ECS and CD patients, QoL correlated with time from first symptoms until diagnosis of CS, but not with urinary-free-cortisol levels or serum cortisol after dexamethasone at time of diagnosis. Long-term outcomes regarding hypertension, metabolic parameters, bone mineral density and grip strength were comparable in ECS and CD. CONCLUSIONS Our data support the concept that time of exposure to glucocorticoid excess appears to be a better predictor than peak serum cortisol levels at time of diagnosis regarding long-term psychiatric morbidity and QoL.

Abstract

OBJECTIVE Aim of our study was to analyze long-term outcome of patients with the ectopic Cushing's syndrome (ECS) compared to patients with Cushing's disease (CD) regarding cardiovascular, metabolic, musculoskeletal and psychiatric co-morbidities. DESIGN Cross-sectional study in patients with ECS and CD in two German academic tertiary-care centers. METHODS Standardized clinical follow-up examination was performed including health-related quality of life (QoL) in 21 ECS patients in long-term remission (≥ 18 months since successful surgery). 59 patients with CD in remission served as controls. RESULTS Time from first symptoms to diagnosis of CS was shorter in ECS than in CD (8.5 (IQR 30.3) vs. 25 (IQR 39.0) months, p=0.050). ECS patients had lower self-reported psychiatric morbidity compared to CD (19% vs. 43%, p=0.050) at follow-up. Moreover, female ECS patients reported favorable scores for QoL in the SF-36 questionnaire (mental health: 92 (IQR 30) vs. 64 (IQR 32) in CD, p=0.010) and a Cushing-specific QoL-questionnaire (73 (IQR 18) vs. 59 (IQR 36) in CD, p=0.030). In a pooled analysis of ECS and CD patients, QoL correlated with time from first symptoms until diagnosis of CS, but not with urinary-free-cortisol levels or serum cortisol after dexamethasone at time of diagnosis. Long-term outcomes regarding hypertension, metabolic parameters, bone mineral density and grip strength were comparable in ECS and CD. CONCLUSIONS Our data support the concept that time of exposure to glucocorticoid excess appears to be a better predictor than peak serum cortisol levels at time of diagnosis regarding long-term psychiatric morbidity and QoL.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Endocrinology and Diabetology
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Endocrinology, Diabetes and Metabolism
Life Sciences > Endocrinology
Uncontrolled Keywords:Endocrinology, Diabetes and Metabolism, Endocrinology, General Medicine
Language:English
Date:6 June 2018
Deposited On:04 Jul 2018 13:01
Last Modified:08 Apr 2020 23:45
Publisher:BioScientifica Ltd.
ISSN:0804-4643
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1530/EJE-18-0212
PubMed ID:29875286

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