Validity of the Cushing’s syndrome severity index in patients with iatrogenic Cushing’s syndrome

Abstract

IntroductionCurrently there are no clinimetric instruments for the measurement of the severity of iatrogenic Cushing's syndrome (ICS). Sonino et al. created a clinical severity index of endogenous Cushing’s disease (CSI) but it has not been applied to patients with ICS. ObjectiveTo validate and determine the utility of the CSI and its correlation with clinical variables in rheumatological patients with continuous use of glucocorticoids (GC). Subjects and methodspatients with a history of continuous systemic GC use (for at least 4 weeks) indicated for treatment of rheumatological disease were included. All the patients filled out a questionnaire on sociodemographic data, characteristics of the CG used; the way of use and the presence or absence of adverse events. The CSI was applied by 2 observers independently. Consistency, interobserver concordance and principal component analysis were calculated. Results32 patients with an average age of 35.72 ± 12.8 years were studied; 29 were women (90.6%). The average CSI score by the first observer was 3.50 ± 2.02, and by the second observer was 2.31 ± 1.75 (P = .004). The interobserver concordance was low in the items with imprecise definitions; for which modifications were made in the definitions to improve their performance. The CSI scores correlated with the presence of adverse effects and the type of dose used. ConclusionsThe CSI has an adequate correlation with clinical manifestations in patients with chronic use of GC. The clinimetric characteristics of the questionnaire improved by standardising the definitions of subjective clinical variables.