Cushing’s syndrome in the elderly: data from ercusyn
V. Amodru*a (Dr), A. Tabarinb (Prof), F. Castinettic (Prof), S. Tsagarakisd (Prof), M. Tothe (Prof), RA. Feeldersf (Prof), SM. Webba (Prof), M. Reinckeg (Prof), R. Netea-Maierh (Prof), D. Kastelani (Prof), A. Elenkovaj (Prof), D. Maiterk (Prof), A. Santosa (Dr), E. Valassil (Prof)
a 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, SPAIN ; b Department of Endocrinology, Diabetes and Nutrition, University of Bordeaux, Bordeaux, FRANCE ; c Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale INSERM U1251, Marseille Medical Genetics, Marseille, France and Assistance Publique Hôpitaux de Marseille (APHM), Hôpital de la Conception, Marseille, FRANCE ; d Evangelismos Hospital, Athens, GREECE ; e Department of Internal Medicine and Oncology, Semmelweis University, Budapest, HUNGARY ; f Erasmus University Medical Centre, Rotterdam, NETHERLANDS ; g Medizinische Klinik und Poliklinik IV, Campus Innestadt, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, GERMANY ; h Department of Internal Medicine, division of Endocrinology, Radboud University Medical Center, Nijmegen, NETHERLANDS ; i Department of Endocrinology, University Hospital Zagreb, Zagreb, CROATIA ; j Medical University of Sofia, Sofia, BULGARIA ; k UCL Cliniques Universitaires St Luc, Brussels, BELGIUM ; l Endocrinology and Nutrition Department, Germans Trias i Pujol Hospital and Research Institute, Universitat Internacional de Catalunia (UIC), Barcelona, SPAIN
In the last decades, life expectancy has improved worldwide and the number of elderly patients referred to endocrine clinics has progressively increased. Data on clinical presentation and management of Cushing’s syndrome (CS) in older patients are scarce.
Our study was aimed at evaluating whether age-related differences exist in terms of clinical characteristics, diagnostic approach and management strategies in patients with CS included in the European Registry on Cushing’s Syndrome (ERCUSYN).
PATIENTS AND METHODS:
We performed a retrospective, observational, multicenter study based on the ERCUSYN registry.
In this cohort study, 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) and 175 (9.8%) as older (>65 years). Of the older patients, 8% had PIT-CS, 12% ADR-CS and 19% ECT-CS. At diagnosis, older patients were more frequently males and had a lower BMI and waist circumference as compared with younger patients. 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<0.01 for all comparisons). Measurement of UFC, the most commonly used test, supported the diagnosis of CS less frequently in older patients as compared with the younger (p<0.05). An extra-sellar macroadenoma was more commonly found in older PIT-CS patients than in the younger (p<0.01). 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<0.01 for all comparisons). However, when transsphenoidal surgery was performed, the remission rate was lower in the elderly as compared with their younger counterparts (p<0.05).
There are significant age-related differences in clinical presentation, management and surgical outcome of CS. Older patients lack several typical symptoms of hypercortisolism and present with an increased comorbidity burden regardless of gender. Conservative management is often the preferred approach in older CS patients.
The author has declared no conflict of interest.