Long-term morbidities in patients with Cushing's disease
Georgia Ntali, Thomas Siamatras, John Komninos, Niki Karavitaki & John Wass
Introduction: Cushings disease (CD) is a rare condition, associated with significant morbidities and potentially fatal, if untreated.
Objective: To assess the long-term morbidities in a large series of patients with CD during a prolonged follow-up period.
Patients and methods: All subjects with CD who presented/followed-up in our Department between 01/1967 and 06/2009 were studied. All information was collected as documented in the records of the patients.
Results: One hundred and eighty-two patients were identified (139 females/43 males). The median age at diagnosis was 40 years (range 1076) (females: 39 (1372) males: 41 (1076)). The mean duration of symptoms prior to diagnosis was 24 months (range 3240) and the mean follow-up period was 145 months (±121). The treatment modalities were: TSA 118 patients (cured 75%), TSA+external radiotherapy 20 (cured 30%), TSA+bilateral adrenalectomy 19 (cured 100%), TSA+bilateral adrenalectomy+external radiotherapy 7 (cured 100%), bilateral adrenalectomy 11 (cured 100%), external radiotherapy 2 (cured 0%). Two patients are waiting for surgery, two had been treated medically due to high surgical risk, and one died before any treatment. At last assessment, 73% of the subjects were considered cured (132/182). The documented rates of morbidities were: hypertension 36% (82% cured), dyslipidaemia 27% (70% cured), DM2 12% (68% cured), depression 15% (82% cured), osteopaenia/osteoporosis 37% (82% cured), cardiovascular disease 9% (69% cured), cerebrovascular disease 4% (71% cured), tumours (meningioma, kidney carcinoma, gastric carcinoma, breast cancer, melanoma, rectal carcinoma) 6% (100% cured), kidney disease 3% (83% cured), gallstones 0.5% (100% cured). Partial or complete hypopituitarism was reported in 64% of the subjects.
Conclusions: Remarkably high proportions of various morbidities in Cushings rectify themselves after the successful treatment of this unpleasant disease but significant morbidities also remain particularly with regard to hypertension, dyslipidaemia, osteopaenia and osteoporosis. These will be likely to have an impact on long-term mortality.