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Excess Morbidity Persists in Patients With Cushings Disease During Long-term Remission: A Swedish Nationwide Study
Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; The Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; The Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; The Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden .
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
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2020 (English)In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 105, no 8, p. 2616-2624Article in journal (Refereed) Published
Abstract [en]

Context: Whether multisystem morbidity in Cushings disease (CD) remains elevated during long-term remission is still undetermined. Objective: To investigate comorbidities in patients with CD. Design, Setting, and Patients: A retrospective, nationwide study of patients with CD identified in the Swedish National Patient Register between 1987 and 2013. Individual medical records were reviewed to verify diagnosis and remission status. Main Outcomes: Standardized incidence ratios (SIRs) with 95% confidence intervals (Os) were calculated by using the Swedish general population as reference. Comorbidities were investigated during three different time periods: (i) during the 3 years before diagnosis, (ii) from diagnosis to 1 year after remission, and (iii) during long-term remission. Results: We included 502 patients with confirmed CD, of whom 419 were in remission for a median of 10 (interquartile range 4 to 21) years. SIRs (95% CI) for myocardial infarction (4.4; 1.2 to 11.4), fractures (4.9; 2.7 to 8.3), and deep vein thrombosis (13.8; 3.8 to 35.3) were increased during the 3-year period before diagnosis. From diagnosis until 1 year after remission, SIRs (95% CI were increased for thromboembolism (18.3; 7.9 to 36.0), stroke (4.9; 1.3 to 12.5), and sepsis (13.6; 3.7 to 34.8). SIRs for thromboembolism (4.9; 2.6 to 8.4), stroke (3.1; 1.8 to 4.9), and sepsis (6.0; 3.1 to 10.6) remained increased during long-term remission. Conclusion: Patients with CD have an increased incidence of stroke, thromboembolism, and sepsis even after remission, emphasizing the importance of early identification and management of risk factors for these comorbidities during long-term follow-up.

Place, publisher, year, edition, pages
ENDOCRINE SOC , 2020. Vol. 105, no 8, p. 2616-2624
Keywords [en]
Cushings disease; remission; comorbidity; cardiovascular; thromboembolism; sepsis
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-170002DOI: 10.1210/clinem/dgaa291ISI: 000565927300073PubMedID: 32436951OAI: oai:DiVA.org:liu-170002DiVA, id: diva2:1470928
Note

Funding Agencies|Swedish government [ALFGBG-593301]; county councils, the ALF-agreement [ALFGBG-593301]; Gothenburg Society of Medicine

Available from: 2020-09-26 Created: 2020-09-26 Last updated: 2021-12-28Bibliographically approved

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Wahlberg, JeanetteEkman, Bertil

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Division of Diagnostics and Specialist MedicineFaculty of Medicine and Health SciencesDepartment of Endocrinology
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