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Excess Morbidity Persists in Patients with Cushing's Disease during Long-term Remission - A Swedish Nationwide Study.

Journal article
Authors Eleni Papakokkinou
Daniel S Olsson
Dimitrios Chantzichristos
Per Dahlqvist
Elin Segerstedt
Tommy Olsson
Maria Petersson
Katarina Berinder
Sophie Bensing
Charlotte Höybye
Britt Edén-Engström
Pia Burman
Lorenza Bonelli
Cecilia Follin
David Petranek
Eva Marie Erfurth
Jeanette Wahlberg
Bertil Ekman
Anna-Karin Åkerman
Erik Schwarcz
Ing-Liss Bryngelsson
Gudmundur Johannsson
Oskar Ragnarsson
Published in The Journal of clinical endocrinology and metabolism
Volume 105
Issue 8
ISSN 1945-7197
Publication year 2020
Published at Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Language en
Keywords Cushing’s disease, cardiovascular, comorbidity, remission, sepsis, thromboembolism
Subject categories Endocrinology


Whether multisystem morbidity in Cushing's disease (CD) remains elevated during long-term remission is still undetermined.To investigate comorbidities in patients with CD.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.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: (a) during the 3 years before diagnosis, (b) from diagnosis to 1 year after remission, and (c) during long-term remission.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 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.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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