Cushing's syndrome in the elderly: data from the European Registry on Cushing's syndrome
Author:
Amodru Vincent123, Ferriere Amandine4, Tabarin Antoine4ORCID, Castinetti Frederic23ORCID, Tsagarakis Stylianos5, Toth Miklos6ORCID, Feelders Richard A7, Webb Susan M1, Reincke Martin8ORCID, Netea-Maier Romana9, Kastelan Darko10, Elenkova Atanaska11, Maiter Dominique12, Ragnarsson Oskar13ORCID, Santos Alicia1, Valassi Elena141516ORCID, Amaral C, Ambrogio A, Aranda G, Arosio M, Balomenaki M, Berr-Kirmair C, Bertherat J, Bolanowski M, Bollerslev J, Cardoso H, Carvalho D, Cavagnini F, Ceccato P, Chabre O, Chanson P, Christ E, Demtröder Zentrum fur Endokrinologie F, Denes J, Deutschbein T, Dimopoulou C, Dreval A, Droste M, Duarte J S, Dusek T, Ertürk E, Evang J A, Fajardo C, Fazel J, Feelders R A, Fica S, García-Centeno R, Ghigo E, Goth M, Godlewska M, Greenman Y, Halperin I, Hanzu F A, Hermus A, Johannsson G, Hubina E, Januszewska A, Kamenicky P, Kasperlik-Zaluska A, Kirchner J, Kastelan D, Komerdus I, Kraljevic I, Krsek M, Kruszynska A, Lamas C, Lambrescu I, Lang S, Luger A, Maiter D, Marpole N, Martin S, Martinie M, Martins Oliveira M J, Moros O, Netea-Maier R, Newell-Price J, Orbetzova M, Paiva I, Pecori Giraldi F, Percovich J C, Pereira A M, Pfeifer M, Pickel J, Pirags V, Ragnarsson O, Reghina A D, Reincke M, Riesgo P, Roberts M, Roerink S, Roig O, Rowan C, Rudenko P, Salvador J, Santos A, Scaroni C, Sigurjonsdottir H A, Skoric Polovina T, Smith R, Stachowska B, Stalla G, Strasburger C, Tabarin A, Terzolo M, Tőke J, Tóth M, Touraine P, Trainer P J, Tsagarakis S, Valassi E, Vila G, Vinay S, Wagenmakers M, Werner S, Young J, Zdunowski P, Zopf K, Zopp S, Zosin I,
Affiliation:
1. IIB-Sant Pau and Department of Endocrinology, Hospital Sant Pau, Dept Medicine, UAB, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII , Barcelona 08025 , Spain 2. Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale INSERM U1251, Marseille Medical Genetics , Marseille , France 3. Assistance Publique Hôpitaux de Marseille (APHM), Hôpital de la Conception , Marseille 13385 , France 4. Department of Endocrinology, Diabetes and Nutrition, University of Bordeaux , Bordeaux 33604 , France 5. Endocrinology Department, Evangelismos Hospital , Athens 10676 , Greece 6. Department of Internal Medicine and Oncology, Semmelweis University , Budapest 1083 , Hungary 7. Endocrinology Department, Erasmus University Medical Centre , Rotterdam 3015 , The Netherlands 8. Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Ludwig-Maximilians-Universität München , Munich 80336 , Germany 9. Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center , Nijmegen 6525 , The Netherlands 10. Department of Endocrinology, University Hospital Zagreb , Zagreb 10000 , Croatia 11. Department of Endocrinology, Medical University of Sofia , Sofia 1431 , Bulgaria 12. Endocrinology Department, UCL Cliniques Universitaires St Luc , Brussels 1200 , Belgium 13. Department of Endocrinology, Sahlgrenska University Hospital , Gothenburg 41345 , Sweden 14. Endocrinology and Nutrition Department, Germans Trias i Pujol Hospital and Research Institute , Badalona 08916 , Spain 15. Research Centre for Pituitary Diseases, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) , Barcelona 08195 , Spain 16. School of Medicine, Universitat Internacional de Catalunia (UIC) , Barcelona 08195 , Spain
Abstract
AbstractObjectiveTo 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).DesignCohort study.MethodsWe 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).ResultsOlder 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).ConclusionsOlder CS patients lack several typical symptoms of hypercortisolism, present with more comorbidities regardless of sex, and are more often conservatively treated.
Funder
EU Novartis Ipsen HRA European Society of Endocrinology
Publisher
Oxford University Press (OUP)
Subject
Endocrinology,General Medicine,Endocrinology, Diabetes and Metabolism
Cited by
12 articles.
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