Objective To evaluate whether age-related differences exist in clinical characteristics, diagnostic approach, and management strategies in patients with Cushing's syndrome (CS) included in the European Registry on Cushing's Syndrome (ERCUSYN). Design Cohort study. Methods We analyzed 1791 patients with CS, of whom 1234 (69%) had pituitary-dependent CS (PIT-CS), 450 (25%) adrenal-dependent CS (ADR-CS), and 107 (6%) had an ectopic source (ECT-CS). According to the WHO criteria, 1616 patients (90.2%) were classified as younger (<65 years old) and 175 (9.8%) as older (>= 65 years old). Results Older patients were more frequently males and had a lower Body Mass Index (BMI) and waist circumference when compared with the younger. Older patients also had a lower prevalence of skin alterations, depression, hair loss, hirsutism, and reduced libido, but a higher prevalence of muscle weakness, diabetes, hypertension, cardiovascular disease, venous thromboembolism, and bone fractures than younger patients, regardless of sex (P < .01 for all comparisons). Measurement of urinary free cortisol supported the diagnosis of CS less frequently in older patients when compared with the younger (P < .05). An extrasellar macroadenoma (macrocorticotropinoma with extrasellar extension) was more common in older PIT-CS patients than in the younger (P < .01). Older PIT-CS patients more frequently received cortisol-lowering medications and radiotherapy as a first-line treatment, whereas surgery was the preferred approach in the younger (P < .01 for all comparisons). When transsphenoidal surgery was performed, the remission rate was lower in the elderly when compared with their younger counterpart (P < .05). Conclusions Older CS patients lack several typical symptoms of hypercortisolism, present with more comorbidities regardless of sex, and are more often conservatively treated.

Cushing's syndrome in the elderly: data from the European Registry on Cushing's syndrome / V. Amodru, A. Ferriere, A. Tabarin, F. Castinetti, S. Tsagarakis, M. Toth, R.A. Feelders, S.M. Webb, M. Reincke, R. Netea-Maier, D. Kastelan, A. Elenkova, D. Maiter, O. Ragnarsson, A. Santos, E. Valassi, C. Amaral, A. Ambrogio, G. Aranda, M. Arosio, M. Balomenaki, C. Berr-Kirmair, J. Bertherat, M. Bolanowski, J. Bollerslev, H. Cardoso, D. Carvalho, F. Cavagnini, P. Ceccato, O. Chabre, P. Chanson, E. Christ, F. Demtröder, J. Denes, T. Deutschbein, C. Dimopoulou, A. Dreval, M. Droste, J.S. Duarte, T. Dusek, E. Ertürk, J.A. Evang, C. Fajardo, J. Fazel, S. Fica, R. García-Centeno, E. Ghigo, M. Goth, M. Godlewska, Y. Greenman, I. Halperin, F.A. Hanzu, A. Hermus, G. Johannsson, E. Hubina, A. Januszewska, P. Kamenicky, A. Kasperlik-Zaluska, J. Kirchner, I. Komerdus, I. Kraljevic, M. Krsek, A. Kruszynska, C. Lamas, I. Lambrescu, S. Lang, A. Luger, N. Marpole, S. Martin, M. Martinie, M.J. Martins Oliveira, O. Moros, J. Newell-Price, M. Orbetzova, I. Paiva, F. Pecori Giraldi, J.C. Percovich, A.M. Pereira, M. Pfeifer, J. Pickel, V. Pirags, A.D. Reghina, P. Riesgo, M. Roberts, S. Roerink, O. Roig, C. Rowan, P. Rudenko, J. Salvador, C. Scaroni, H.A. Sigurjonsdottir, T. Skoric Polovina, R. Smith, B. Stachowska, G. Stalla, C. Strasburger, M. Terzolo, J. Tőke, P. Touraine, P.J. Trainer, G. Vila, S. Vinay, M. Wagenmakers, S. Werner, J. Young, P. Zdunowski, K. Zopf, S. Zopp, I. Zosin. - In: EUROPEAN JOURNAL OF ENDOCRINOLOGY. - ISSN 0804-4643. - 188:4(2023 Apr), pp. 395-406. [10.1093/ejendo/lvad008]

Cushing's syndrome in the elderly: data from the European Registry on Cushing's syndrome

F. Pecori Giraldi;
2023

Abstract

Objective To evaluate whether age-related differences exist in clinical characteristics, diagnostic approach, and management strategies in patients with Cushing's syndrome (CS) included in the European Registry on Cushing's Syndrome (ERCUSYN). Design Cohort study. Methods We analyzed 1791 patients with CS, of whom 1234 (69%) had pituitary-dependent CS (PIT-CS), 450 (25%) adrenal-dependent CS (ADR-CS), and 107 (6%) had an ectopic source (ECT-CS). According to the WHO criteria, 1616 patients (90.2%) were classified as younger (<65 years old) and 175 (9.8%) as older (>= 65 years old). Results Older patients were more frequently males and had a lower Body Mass Index (BMI) and waist circumference when compared with the younger. Older patients also had a lower prevalence of skin alterations, depression, hair loss, hirsutism, and reduced libido, but a higher prevalence of muscle weakness, diabetes, hypertension, cardiovascular disease, venous thromboembolism, and bone fractures than younger patients, regardless of sex (P < .01 for all comparisons). Measurement of urinary free cortisol supported the diagnosis of CS less frequently in older patients when compared with the younger (P < .05). An extrasellar macroadenoma (macrocorticotropinoma with extrasellar extension) was more common in older PIT-CS patients than in the younger (P < .01). Older PIT-CS patients more frequently received cortisol-lowering medications and radiotherapy as a first-line treatment, whereas surgery was the preferred approach in the younger (P < .01 for all comparisons). When transsphenoidal surgery was performed, the remission rate was lower in the elderly when compared with their younger counterpart (P < .05). Conclusions Older CS patients lack several typical symptoms of hypercortisolism, present with more comorbidities regardless of sex, and are more often conservatively treated.
Cushing's syndrome; ERCUSYN; aging; elderly patients
Settore MEDS-08/A - Endocrinologia
apr-2023
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/1097189
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