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Increased Mortality Persists after Treatment of Cushing's Disease: A Matched Nationwide Cohort Study

Bengtsson, Daniel, 1975- (author)
Linköpings universitet,Linköping University,Avdelningen för kirurgi, ortopedi och onkologi,Medicinska fakulteten,Department of Internal Medicine, Kalmar, Region of Kalmar County, Kalmar, Sweden
Ragnarsson, Oskar, 1971 (author)
Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden,Univ Gothenburg, Inst Med, Dept Internal Med & Clin Nutr, Sahlgrenska Acad, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Dept Endocrinol, Gothenburg, Sweden.
Berinder, K. (author)
Karolinska Institutet,Karolinska Institute,Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Dahlqvist, Per (author)
Umeå University,Umeå universitet,Avdelningen för medicin,Umeå Univ, Dept Publ Hlth & Clin Med, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
Edén Engström, Britt (author)
Uppsala University,Uppsala universitet,Endokrinologi och mineralmetabolism,Uppsala Univ Hosp, Dept Endocrinol & Diabet, Uppsala, Sweden.,Department of Medical Sciences, Endocrinology and Mineral Metabolism, Uppsala University, Uppsala, Sweden; Department of Endocrinology and Diabetes, Uppsala University Hospital, Uppsala, Sweden
Ekman, Bertil, 1958- (author)
Linköpings universitet,Linköping University,Avdelningen för diagnostik och specialistmedicin,Medicinska fakulteten,Region Östergötland, Endokrinmedicinska kliniken
Hoybye, C. (author)
Karolinska Institutet,Karolinska Institute,Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
Jaras, J. (author)
Regional Cancer Centre, Stockholm/Gotland, Stockholm, Sweden,Reg Canc Ctr, Stockholm, Sweden.
Valdemarsson, Stig (author)
Lund University,Lunds universitet,Medicin/akutsjukvård, Lund,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Medicine, Lund,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Department of Clinical Sciences, Skåne University Hospital, University of Lund, Lund, Sweden
Burman, Pia (author)
Lund University,Lunds universitet,Translationell muskelforskning,Forskargrupper vid Lunds universitet,Translational Muscle Research,Lund University Research Groups,Department of Endocrinology, Skåne University Hospital, University of Lund, Malmö, Sweden
Wahlberg, Jeanette, 1969- (author)
Linköpings universitet,Örebro University,Linköping University,Örebro universitet,Institutionen för medicinska vetenskaper,Department Of Endocrinology, Linköping University, Linköping, Sweden; Department Of Health Medicine And Caring Sciences, Linköping University, Linköping, Sweden; Faculty Of Medical Sciences, Örebro University, Örebro, Sweden,Linköping Univ, Dept Endocrinol, Linköping, Sweden.;Linköping Univ, Dept Hlth Med & Caring Sci, Linköping, Sweden.;Örebro Univ, Fac Med Sci, Örebro, Sweden.,Avdelningen för diagnostik och specialistmedicin,Medicinska fakulteten,Region Östergötland, Endokrinmedicinska kliniken
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 (creator_code:org_t)
2022-03-18
2022
English.
In: Journal of the Endocrine Society. - : The Endocrine Society. - 2472-1972. ; 6:6
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  • Journal article (peer-reviewed)
Abstract Subject headings
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  • Context: Whether biochemical remission normalizes life expectancy in Cushing's disease (CD) patients remains unclear. Previous studies evaluating mortality in CD are limited by using the expected number of deaths in the background population instead of the actual number in matched controls. Objective and setting: To study mortality by time-to-event analysis in an unselected nationwide CD patient cohort. Design and participants: Longitudinal data from the Swedish Pituitary Register of 371 patients diagnosed with CD from 1991 to 2018 and information from the Swedish Cause of Death Register were evaluated. Four controls per patient (n = 1484) matched at the diagnosis date by age, sex, and residential area were included. Main outcome measures: Mortality and causes of death. Results: The median diagnosis age was 44 years (interquartile range 32-56), and the median follow-up was 10.6 years (5.7-18.0). At the 1-, 5-, 10-, 15-, and 20-year follow-ups, the remission rates were 80%, 92%, 96%, 91%, and 97%, respectively. Overall mortality was increased in CD patients compared with matched controls [hazard ratio (HR) 2.1 (95% CI 1.5-2.8)1. The HRs were 1.5 (1.02-2.2) for patients in remission at the last follow-up In = 303), 1.7 (1.03-2.8) for those in remission after a single pituitary surgery In = 177), and 5.6 (2.7-11.6) for those not in remission (n = 31). Cardiovascular diseases (32/66) and infections (12/66) were overrepresented causes of death. Conclusions: Mortality was increased in CD patients despite biochemical remission compared to matched controls. The study highlights the importance of careful comorbidity monitoring, regardless of remission status.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Endokrinologi och diabetes (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Endocrinology and Diabetes (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Gastroenterologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Gastroenterology and Hepatology (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine (hsv//eng)

Keyword

Cushing
hypercortisolism
mortality
remission
hazard ratio
epidemiology
morbidity
complications
predictors
management
remission
Endocrinology & Metabolism
Cushing

Publication and Content Type

ref (subject category)
art (subject category)

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