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. 2019 Feb 19:2019:7159696.
doi: 10.1155/2019/7159696. eCollection 2019.

Demographic Characteristics, Etiology, and Comorbidities of Patients with Cushing's Syndrome: A 10-Year Retrospective Study at a Large General Hospital in China

Jingya Zhou  1   2 , Meng Zhang  1   2 , Xue Bai  1   2 , Shengnan Cui  1   2 , Cheng Pang  1   2 , Lin Lu  3   4 , Haiyu Pang  5   6 , Xiaopeng Guo  4   7   8 , Yi Wang  1   2 , Bing Xing  4   7   8
Affiliations

Demographic Characteristics, Etiology, and Comorbidities of Patients with Cushing's Syndrome: A 10-Year Retrospective Study at a Large General Hospital in China

Jingya Zhou et al. Int J Endocrinol. .

Abstract

Purpose: To investigate the demographic characteristics, etiology, and comorbidities of Cushing's syndrome (CS) patients at a large medical center in China.

Methods: Records on CS patients discharged from 2008 to 2017 were retrieved from the hospital discharge abstract database (DAD) using ICD-10 codes. Demographic characteristics, etiology, and comorbidity data were analyzed.

Results: Cushing's disease (CD) accounted for 63.0% of CS patients, followed by adrenocortical adenoma (ACA) (20.9%), primary bilateral macronodular adrenal hyperplasia (BMAH) (6.2%), ectopic ACTH syndrome (EAS) (5.9%), primary pigmented nodular adrenocortical disease (PPNAD) (1.8%), and adrenocortical carcinoma (ACC) (1.0%). CD, ACA, ACC, and PPNAD presented marked preponderances in women (4.1 : 1, 10.5 : 1, 4.3 : 1, and 2.3 : 1, respectively), while BMAH (59.8%) and EAS (51.0%) showed slightly higher preponderances in men. CD patients were younger than ACA and EAS patients (36.1 ± 12.9 years vs. 39.4 ± 12.7 years and 36.1 ± 12.9 years vs. 41.0 ± 15.8, P < 0.001); PPNAD patients were the youngest (24.2 ± 10.8 years, P < 0.001), and BMAH patients were the oldest (51.3 ± 9.9 years, P < 0.001). Hypertension, diabetes mellitus, osteoporosis without fractures, osteoporotic fractures, dyslipidemia, and fatty liver occurred more frequently in CD patients than in ACA patients (P < 0.001 for all). Osteoporotic fractures were observed more frequently in PPAND than in ACA (26.7% vs. 9.0%, P < 0.001) and BMAH (26.7% vs. 4.9%, P < 0.001) patients. EAS patients had more severe and diverse comorbidities, with higher prevalences of hypokalemia (52.0%), diabetes mellitus (61.2%), and osteoporotic fractures (28.6%). When adjusted for age, male CD patients were associated with hypertension (OR = 2.266, 95% CI: 1.524-3.371, and P < 0.001), osteoporotic fractures (OR = 2.274, 95% CI: 1.568-3.298, and P < 0.001), fatty liver (OR = 1.435, 95% CI: 1.028-2.003, and P = 0.034), and hypokalemia (OR = 1.944, 95% CI: 1.280-2.951, and P = 0.002).

Conclusions: The proposed method efficiently evaluates CS patients' epidemiological profiles using hospital DADs with ICD-10 codes and thus may enrich the limited epidemiological data and contribute to clinical practice for CS.

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Figures

Figure 1
Figure 1
Time trend of CS patients by etiology from 2008 to 2017.
Figure 2
Figure 2
Proportion of causes of Cushing's syndrome.
See this image and copyright information in PMC

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