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Mortality and morbidity in Cushing’s syndrome in New Zealand
Author(s) -
Bolland Mark J.,
Holdaway Ian M.,
Berkeley Juliet E.,
Lim Sarina,
Dransfield Will J.,
Conaglen John V.,
Croxson Michael S.,
Gamble Greg D.,
Hunt Penny J.,
Toomath Robyn J.
Publication year - 2011
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2011.04124.x
Subject(s) - medicine , population , diabetes mellitus , incidence (geometry) , pediatrics , mortality rate , standardized mortality ratio , osteoporosis , retrospective cohort study , endocrinology , physics , environmental health , optics
Summary Objective Untreated Cushing’s syndrome (CS) is associated with significant morbidity and mortality. However, recent operative series suggest low morbidity and mortality for CS, whereas population‐based surveys report elevated mortality rates. We investigated the mortality and morbidity of CS in New Zealand. Design A nationwide retrospective survey of patients with CS between 1960 and 2005 managed at the four main endocrinology services. Patients A total of 253 patients with CS were identified, excluding adrenal carcinoma and malignant ectopic CS. Measurements The primary outcome was the standardized mortality ratio (SMR), comparing the observed number of deaths with the expected number for the population matched for age, sex and duration of follow‐up. Secondary outcomes were the change in prevalence of co‐morbidities at presentation and at final follow‐up. Results The approximate prevalence and incidence of CS was 79/million and 1·8/million/y. The mean age at presentation was 39 year, and median duration of follow‐up was 6·4 year (range 0–46). Overall, 89% achieved biochemical cure at last follow‐up, with >90% achieving biochemical cure for CS from adrenal adenoma and pituitary causes. Thirty‐six patients died during follow‐up compared with 8·8 expected deaths (SMR 4·1, 95%CI 2·9–5·6). While hypertension, sexual dysfunction, myopathy and mild psychiatric illness were significantly reduced after treatment, hypertension, diabetes mellitus, moderate or major psychiatric illness, and osteoporosis were common at final follow‐up. Conclusion CS is associated with both high mortality and a high prevalence of co‐morbidities, even when biochemical cure rates are between 80% and 90%.