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Excess Morbidity Persists in Patients With Cushing's Disease During Long-term Remission : A Swedish Nationwide Study

Papakokkinou, Eleni ; Olsson, Daniel S. ; Chantzichristos, Dimitrios ; Dahlqvist, Per ; Segerstedt, Elin ; Olsson, Tommy ; Petersson, Maria ; Berinder, Katarina ; Bensing, Sophie and Höybye, Charlotte , et al. (2020) In The Journal of clinical endocrinology and metabolism 105(8).
Abstract

CONTEXT: Whether multisystem morbidity in Cushing's 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 (CIs) 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... (More)

CONTEXT: Whether multisystem morbidity in Cushing's 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 (CIs) 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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cardiovascular, comorbidity, Cushing’s disease, remission, sepsis, thromboembolism
in
The Journal of clinical endocrinology and metabolism
volume
105
issue
8
article number
dgaa291
publisher
Oxford University Press
external identifiers
  • scopus:85086792735
  • pmid:32436951
ISSN
1945-7197
DOI
10.1210/clinem/dgaa291
language
English
LU publication?
yes
id
d68ede31-b1b3-4360-8d7a-1ff211ae88ac
date added to LUP
2020-07-07 10:37:50
date last changed
2020-09-24 10:00:11
@article{d68ede31-b1b3-4360-8d7a-1ff211ae88ac,
  abstract     = {<p>CONTEXT: Whether multisystem morbidity in Cushing's 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 (CIs) 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.</p>},
  author       = {Papakokkinou, Eleni and Olsson, Daniel S. and Chantzichristos, Dimitrios and Dahlqvist, Per and Segerstedt, Elin and Olsson, Tommy and Petersson, Maria and Berinder, Katarina and Bensing, Sophie and Höybye, Charlotte and Edén-Engström, Britt and Burman, Pia and Bonelli, Lorenza and Follin, Cecilia and Petranek, David and Erfurth, Eva Marie and Wahlberg, Jeanette and Ekman, Bertil and Åkerman, Anna Karin and Schwarcz, Erik and Bryngelsson, Ing Liss and Johannsson, Gudmundur and Ragnarsson, Oskar},
  issn         = {1945-7197},
  language     = {eng},
  number       = {8},
  publisher    = {Oxford University Press},
  series       = {The Journal of clinical endocrinology and metabolism},
  title        = {Excess Morbidity Persists in Patients With Cushing's Disease During Long-term Remission : A Swedish Nationwide Study},
  url          = {http://dx.doi.org/10.1210/clinem/dgaa291},
  doi          = {10.1210/clinem/dgaa291},
  volume       = {105},
  year         = {2020},
}