Demographic Characteristics, Etiology, and Comorbidities of Patients with Cushing's Syndrome: A 10-Year Retrospective Study at a Large General Hospital in China.

Jingya Zhou,Lin Lu,Bing Xing,Shengnan Cui,Xiaopeng Guo,Meng Zhang,Cheng Pang,Xue Bai,Yi Wang,Haiyu Pang

doi:10.1155/2019/7159696

Abstract

Purpose To investigate the demographic characteristics, etiology, and comorbidities of Cushing's syndrome (CS) patients at a large medical center in China. Methods Records on CS patients discharged from 2008 to 2017 were retrieved from the hospital discharge abstract database (DAD) using ICD-10 codes. Demographic characteristics, etiology, and comorbidity data were analyzed. Results Cushing's disease (CD) accounted for 63.0% of CS patients, followed by adrenocortical adenoma (ACA) (20.9%), primary bilateral macronodular adrenal hyperplasia (BMAH) (6.2%), ectopic ACTH syndrome (EAS) (5.9%), primary pigmented nodular adrenocortical disease (PPNAD) (1.8%), and adrenocortical carcinoma (ACC) (1.0%). CD, ACA, ACC, and PPNAD presented marked preponderances in women (4.1 : 1, 10.5 : 1, 4.3 : 1, and 2.3 : 1, respectively), while BMAH (59.8%) and EAS (51.0%) showed slightly higher preponderances in men. CD patients were younger than ACA and EAS patients (36.1 ± 12.9 years vs. 39.4 ± 12.7 years and 36.1 ± 12.9 years vs. 41.0 ± 15.8, P < 0.001); PPNAD patients were the youngest (24.2 ± 10.8 years, P < 0.001), and BMAH patients were the oldest (51.3 ± 9.9 years, P < 0.001). Hypertension, diabetes mellitus, osteoporosis without fractures, osteoporotic fractures, dyslipidemia, and fatty liver occurred more frequently in CD patients than in ACA patients (P < 0.001 for all). Osteoporotic fractures were observed more frequently in PPAND than in ACA (26.7% vs. 9.0%, P < 0.001) and BMAH (26.7% vs. 4.9%, P < 0.001) patients. EAS patients had more severe and diverse comorbidities, with higher prevalences of hypokalemia (52.0%), diabetes mellitus (61.2%), and osteoporotic fractures (28.6%). When adjusted for age, male CD patients were associated with hypertension (OR = 2.266, 95% CI: 1.524–3.371, and P < 0.001), osteoporotic fractures (OR = 2.274, 95% CI: 1.568–3.298, and P < 0.001), fatty liver (OR = 1.435, 95% CI: 1.028–2.003, and P = 0.034), and hypokalemia (OR = 1.944, 95% CI: 1.280–2.951, and P = 0.002). Conclusions The proposed method efficiently evaluates CS patients' epidemiological profiles using hospital DADs with ICD-10 codes and thus may enrich the limited epidemiological data and contribute to clinical practice for CS.

Highlights

Endogenous Cushing’s syndrome (CS) comprises signs and symptoms caused by elevated serum cortisol, which seriously affects the endocrine and metabolic systems
Endogenous CS is divided into adrenocorticotropic hormone- (ACTH-) dependent and ACTH-independent etiologies, with the former including Cushing’s disease (CD) and ectopic ACTH syndrome (EAS) and the latter including adrenocortical adenoma (ACA), adrenocortical carcinoma (ACC), primary bilateral macronodular adrenal hyperplasia (BMAH), and primary pigmented nodular adrenocortical disease (PPNAD) [1]
The present study investigated the demographic characteristics, etiology, and comorbidities of CS at Peking Union Medical College Hospital (PUMCH) over the last ten years based on the hospital discharge abstract data (DAD), which could enrich the basic epidemiological data and contribute to clinical practice for CS

Summary

Introduction

Endogenous Cushing’s syndrome (CS) comprises signs and symptoms caused by elevated serum cortisol, which seriously affects the endocrine and metabolic systems. Epidemiological studies of CS based on ICD-10 codes have been limited to a specific cause of CS, a certain age group of CS patients, or a CS population with no specific cause, including reports from the United States on CS and CD incidence and on the demographic factors and outcomes of CD patients undergoing surgery [4, 5] in addition to a national population-based study of CS and a cohort study of CS in children and adolescents, both from Denmark [9, 10]. The present study investigated the demographic characteristics, etiology, and comorbidities of CS at Peking Union Medical College Hospital (PUMCH) over the last ten years based on the hospital DAD, which could enrich the basic epidemiological data and contribute to clinical practice for CS

Methods

Results

Conclusion