Frequency of clinical signs in patients with Cushing's syndrome and mild autonomous cortisol secretion: overlap is common
Authors' conclusion
The phenotypic landscape of CS is quite variable. The frequency of comorbidities is similar between patients with CS and MACS. A relevant number of patients with overt CS have just a few clinical signs. There is also an overlap in frequency of symptoms and clinical signs between patients with CS and MACS. According to the current guidelines, 96% of our patients with MACS fall into the category "consideration of adrenalectomy". This should be kept in mind when making treatment decisions in the latter group of patients.
Study context
- Population
- Patients with overt cushing's syndrome (CS) (129) and mild autonomous cortisol secretion (MACS) (48) included prospectively at time of diagnosis, German Cushing's registry129 CS, 48 MACS
- Participants
- 85 / 32 / 12 / 48
- Exposure
- Overt CS vs MACS
- Pituitary CSn = 85
- Adrenal CSn = 32
- Ectopic CSn = 12
- MACSn = 48reference
- Outcome
- Number of comorbidities and clinical signs and symptoms
- Follow-up
- Time of diagnosis
Methodological detailsGerman Cushing's registry, standardized assessment
- German Cushing's registry
- Standardized assessment
Main finding
As reported in the abstract
Pituitary CS
2
range 1–3
Adrenal CS
3
range 2–4
Ectopic CS
3
range 2–4
MACS
3
range 2–3
- All CS: average comorbidities (range 1-3)
- 2
Observational data: associations, not effects.
Further findings
- Hypertension (most common comorbidity) · time of diagnosis — MACS
- 87%
- Clinical signs (of 11) · time of diagnosis — MACS
- average 2 (range 1–3) clinical signs
- Hypertension (most common comorbidity) — Hypertension across CS subtypes
- 78%-92%
- Clinical signs (of 11) — All CS: average clinical signs
- 5
- Clinical signs (of 11) — CS with 0-3 signs
- 28%
- Clinical signs (of 11) — CS with 4-7 signs
- 50%
- Clinical signs (of 11) — CS with >7 signs
- 22%
Original publication
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