Acute and Life-threatening Complications in Cushing Syndrome: Prevalence, Predictors, and Mortality

作者：Marie Helene Schernthaner-Reiter, Christina Siess, Alexander Micko, Christian Zauner, Stefan Wolfsberger, Christian Scheuba, Philipp Riss, Engelbert Knosp, Alexandra Kautzky‐Willer, Anton Luger, Greisa Vila · 发表于：The Journal of Clinical Endocrinology & Metabolism · 年份：2021 · DOI：10.1210/clinem/dgab058 · 被引用次数：47 · 研究领域：Pituitary Gland Disorders and Treatments、Adrenal Hormones and Disorders、Growth Hormone and Insulin-like Growth Factors

CONTEXT: Cushing syndrome (CS) results in significant morbidity and mortality. OBJECTIVE: To study acute and life-threatening complications in patients with active CS. METHODS: We performed a retrospective cohort study using inpatient and outpatient records of patients with CS in a tertiary center. A total of 242 patients with CS were included, including 213 with benign CS (pituitary n = 101, adrenal n = 99, ectopic n = 13), and 29 with malignant disease. We collected acute complications necessitating hospitalization, from appearance of first symptoms of hypercortisolism until 1 year after biochemical remission. Mortality data were obtained from the national registry. Baseline factors relating to and predicting acute complications were tested using uni- and multivariate analysis. RESULTS: The prevalence of acute complications was 62% in patients with benign pituitary CS, 40% in patients with benign adrenal CS, and 100% in patients with ectopic CS. Complications observed in patients with benign CS included infections (25%), thromboembolic events (17%), hypokalemia (13%), hypertensive crises (9%), cardiac arrhythmias (5%), and acute coronary events (3%). Among these patients, 23% had already been hospitalized for acute complications before CS was suspected, and half of complications occurred after the first surgery. Glycated hemoglobin (HbA1c) and 24-hour urinary free cortisol positively correlated with the number of acute complications per patient. Patients with malignant dise...