Cushing's syndrome in the elderly: data from the European Registry on Cushing's syndrome
Por:
Amodru, V, Ferriere, A, Tabarin, A, Castinetti, F, Tsagarakis, S, Toth, M, Feelders, RA, Webb, SM, Reincke, M, Netea-Maier, R, Kastelan, D, Elenkova, A, Maiter, D, Ragnarsson, O, Santos, A, Valass, E, ERCUSYN Study Grp
Publicada:
5 abr 2023
Resumen:
Objective To evaluate whether age-related differences exist in clinical characteristics, diagnostic approach, and management strategies in patients with Cushing's syndrome (CS) included in the European Registry on Cushing's Syndrome (ERCUSYN). Design Cohort study. Methods We analyzed 1791 patients with CS, of whom 1234 (69%) had pituitary-dependent CS (PIT-CS), 450 (25%) adrenal-dependent CS (ADR-CS), and 107 (6%) had an ectopic source (ECT-CS). According to the WHO criteria, 1616 patients (90.2%) were classified as younger (<65 years old) and 175 (9.8%) as older (>= 65 years old). Results Older patients were more frequently males and had a lower Body Mass Index (BMI) and waist circumference when compared with the younger. Older patients also had a lower prevalence of skin alterations, depression, hair loss, hirsutism, and reduced libido, but a higher prevalence of muscle weakness, diabetes, hypertension, cardiovascular disease, venous thromboembolism, and bone fractures than younger patients, regardless of sex (P < .01 for all comparisons). Measurement of urinary free cortisol supported the diagnosis of CS less frequently in older patients when compared with the younger (P < .05). An extrasellar macroadenoma (macrocorticotropinoma with extrasellar extension) was more common in older PIT-CS patients than in the younger (P < .01). Older PIT-CS patients more frequently received cortisol-lowering medications and radiotherapy as a first-line treatment, whereas surgery was the preferred approach in the younger (P < .01 for all comparisons). When transsphenoidal surgery was performed, the remission rate was lower in the elderly when compared with their younger counterpart (P < .05). Conclusions Older CS patients lack several typical symptoms of hypercortisolism, present with more comorbidities regardless of sex, and are more often conservatively treated.
Filiaciones:
Amodru, V:
Hosp Santa Creu & Sant Pau, Dept Med, IIB St Pau, UAB,ISCIII, Barcelona 08025, Spain
Ctr Invest Biomed Red Enfermedades Raras, Un 747, CIBER ER, ISCIII, Barcelona 08025, Spain
Hosp Santa Creu & Sant Pau, Dept Endocrinol, Dept Med, UAB,ISCIII, Barcelona 08025, Spain
Aix Marseille Univ, Inst Natl Sante Rech Med, INSERM, Marseille Med Genet,U1251, Marseille, France
Hop Conception, Assistance Publ Hop Marseille APHM, F-13385 Marseille, France
Ferriere, A:
Univ Bordeaux, Dept Endocrinol Diabet & Nutr, F-33604 Bordeaux, France
Tabarin, A:
Univ Bordeaux, Dept Endocrinol Diabet & Nutr, F-33604 Bordeaux, France
Castinetti, F:
Aix Marseille Univ, Inst Natl Sante Rech Med, INSERM, Marseille Med Genet,U1251, Marseille, France
Hop Conception, Assistance Publ Hop Marseille APHM, F-13385 Marseille, France
Tsagarakis, S:
Evangelismos Med Ctr, Endocrinol Dept, Athens 10676, Greece
Toth, M:
Semmelwe Univ, Dept Internal Med & Oncol, H-1083 Budapest, Hungary
Feelders, RA:
Erasmus Univ, Endocrinol Dept, Med Ctr, NL-3015 Rotterdam, Netherlands
Webb, SM:
Hosp Santa Creu & Sant Pau, Dept Med, IIB St Pau, UAB,ISCIII, Barcelona 08025, Spain
Ctr Invest Biomed Red Enfermedades Raras, Un 747, CIBER ER, ISCIII, Barcelona 08025, Spain
Hosp Santa Creu & Sant Pau, Dept Endocrinol, Dept Med, UAB,ISCIII, Barcelona 08025, Spain
Reincke, M:
Klinikum Univ Munchen, Ludwig Maximilians Univ Munchen, Med Klin & Poliklin 4, Campus Innenstad, D-80336 Munich, Germany
Netea-Maier, R:
Radboud Univ Nijmegen, Dept Internal Med, Div Endocrinol, Med Ctr, NL-6525 Nijmegen, Netherlands
Kastelan, D:
Univ Hosp Zagreb, Dept Endocrinol, Zagreb 10000, Croatia
Elenkova, A:
Med Univ Sofia, Dept Endocrinol, Sofia 1431, Bulgaria
Maiter, D:
UCL Clin Univ St Luc, Endocrinol Dept, B-1200 Brussels, Belgium
Ragnarsson, O:
Sahlgrens Univ Hosp, Dept Endocrinol, S-41345 Gothenburg, Sweden
Santos, A:
Hosp Santa Creu & Sant Pau, Dept Med, IIB St Pau, UAB,ISCIII, Barcelona 08025, Spain
Ctr Invest Biomed Red Enfermedades Raras, Un 747, CIBER ER, ISCIII, Barcelona 08025, Spain
Hosp Santa Creu & Sant Pau, Dept Endocrinol, Dept Med, UAB,ISCIII, Barcelona 08025, Spain
Valass, E:
Germans Trias I Pujol Hosp & Res Inst, Endocrinol & Nutr Dept, Badalona 08916, Spain
Ctr Invest Biomed Red Enfermedades Raras CIBERER, Res Ctr Pituitary Dis, Barcelona 08195, Spain
Univ Int Catalunia UIC, Sch Med, Barcelona 08195, Spain
Germans Trias I Pujol Hosp, Res Inst, Endocrinol Dept, Carretera Canyet, S-N, Badalona 08916, Barcelona, Spain
Green Published, All Open Access; Green Open Access
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