Background: Sex differences in clinical picture of ACTH-dependent Cushings syndrome are controversial, except for the known higher prevalence in females. We compared a broad range of potential differences to enable a more accurate understanding of the clinical picture of sex-specific ACTH-dependent Cushings syndrome.
Design: Cohort study.
Methods: We included consecutive patients with ACTH-dependent Cushings syndrome from Leiden and Berlin diagnosed between 20002016, comparing clinical presentation, biochemical parameters, diagnostic tests, surgical outcome, and comorbidities between men and women.
Results: We included 130 patients: 37 males and 93 females. With similar serum cortisol levels, ACTH levels were higher in males than females at time of diagnosis (median: 116 ng/L versus 57 ng/L). The prevalence of osteoporosis was higher in males than in females (48.6% versus 25.0%), persisting after surgery, with more vertebral fractures (16.2% versus 5.4%) before surgery. Males showed more anemia (75.9% versus 36.8%) after surgery. There were no differences in etiology, pituitary tumor size, diagnostic and therapeutic strategy, or surgical outcome between sexes.
Conclusions: Based on this study, males and females with ACTH-dependent Cushings syndrome present different clinical patterns. However, these differences do not justify different diagnostic strategies or treatment based on sex, considering the similar surgical outcome. Clinicians should be alert to diagnose accompanying osteoporosis (with fractures) and anemia in male patients with ACTH-dependent Cushings syndrome.
18 - 21 May 2019
European Society of Endocrinology