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. 2023 Apr 5;188(4):395-406.
doi: 10.1093/ejendo/lvad008.

Cushing's syndrome in the elderly: data from the European Registry on Cushing's syndrome

Vincent Amodru  1   2   3 , Amandine Ferriere  4 , Antoine Tabarin  4 , Frederic Castinetti  2   3 , Stylianos Tsagarakis  5 , Miklos Toth  6 , Richard A Feelders  7 , Susan M Webb  1 , Martin Reincke  8 , Romana Netea-Maier  9 , Darko Kastelan  10 , Atanaska Elenkova  11 , Dominique Maiter  12 , Oskar Ragnarsson  13 , Alicia Santos  1 , Elena Valassi  14   15   16 ; and for the ERCUSYN Study Group
Collaborators, Affiliations
Free article

Cushing's syndrome in the elderly: data from the European Registry on Cushing's syndrome

Vincent Amodru et al. Eur J Endocrinol. .
Free article

Abstract

Objective: To 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).

Design: Cohort study.

Methods: 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 old) and 175 (9.8%) as older (≥65 years old).

Results: Older 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).

Conclusions: Older CS patients lack several typical symptoms of hypercortisolism, present with more comorbidities regardless of sex, and are more often conservatively treated.

Keywords: Cushing's syndrome; ERCUSYN; aging; elderly patients.

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Conflict of interest statement

Conflicts of interest: M.R. received consulting fees from Novartis, Recordati, Crinetics, HRA Pharma, and Ipsen during the past 5 years. D.K. received consulting fees from Recordati Rare Disease and HRA Pharma Rare Diseases.

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