Endocrine Abstracts (2011) 26 P21

Mortality and morbidity in Cushing's syndrome: a single centre experience

P Vitale, A Cozzolino, M De Leo, C Simeoli, M Galdiero, L F S Grasso, A Colao & R Pivonello

Department of Clinical and Molecular Endocrinology and Oncology, ‘Federico II’ University, Naples, Campania, Italy.

Cushing’s syndrome (CS) is a severe disease caused by an endogenous glucocorticoid excess and it is correlated to an increased morbidity and mortality especially for sepsis and cardiovascular diseases, while hypertension, glucose intolerance or diabetes mellitus, and dyslipidemia are the most common systemic complications. The aim of this retrospective study was to evaluate the mortality and morbidity of patients with CS admitted at the Department of Endocrinology and Oncology of ‘Federico II’ University of Naples during the period from 1980 to 2010. Excluding patients with adrenal carcinomas, data were available for 66 patients with CS (15 males and 51 females), with the following distribution of etiology: 53 (80%) patients with pituitary tumors, seven (11%) with adrenal adenomas, six (9%) with ectopic CS due to bronchial, thymic or pancreatic carcinoids. The overall mortality amounts to 8/66 (12%); in particular, the mortality accounted for 7.5% (4/53) in patients with pituitary tumors and for 50% (3/6) in patients with ectopic CS. One single case of adrenal adenoma died. With the exception of unknown causes (2/8, 25%), heart stroke (2/8, 25%) and heart failure (2/8, 25%) represented the most frequent causes of death, followed by renal failure (1/8, 12.5%) and sepsis (1/8, 12.5%). As far as systemic complications were concerned, dyslipidemia (38/66, 57%) was the most common, immediately followed by hypertension (37/66, 56%), coagulopathy and glucose intolerance (35/66, 53% and 33/66, 50%, respectively), and followed at fair distance by heart diseases (especially ischemic events) (23/66, 35%), psychiatric diseases (mainly depression) (22/66, 33%), severe infections (11/66, 17%) and brain diseases (4/66, 6%). Hypertension was present in 8/8 (100%) dead patients, glucose intolerance or diabetes mellitus, coagulopathy and heart disease in 7/8 (87%), dyslipidemia in 6/8 (75%) and severe infections, psychiatric diseases and brain diseases in 4/8 (50%), 2/8 (25%) and 1/8 (12.5%), respectively. In conclusion, the results of this retrospective single centre study confirmed that CS is associated to an increased morbidity especially for metabolic and cardiovascular diseases, and that mortality of these patients are generally consequence of cardiovascular accidents or septic complication of severe infections, strongly suggesting that these condition predisposing to death needs to be carefully monitored.

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