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- Title
Epidemiology and Comorbidity of Adrenal Cushing Syndrome: A Nationwide Cohort Study.
- Authors
Chang Ho Ahn; Jung Hee Kim; Man Young Park; Sang Wan Kim; Ahn, Chang Ho; Kim, Jung Hee; Park, Man Young; Kim, Sang Wan
- Abstract
<bold>Context: </bold>Adrenal Cushing syndrome (CS) is a major subtype of CS and has a high surgical cure rate. However, only a few studies have investigated the epidemiology and long-term outcomes of adrenal CS.<bold>Objective: </bold>We aimed to investigate the nationwide epidemiology, long-term prognosis, and postoperative glucocorticoid replacement therapies of adrenal CS in Korea.<bold>Design: </bold>Retrospective cohort study.<bold>Setting: </bold>A nationwide claim database.<bold>Patients: </bold>Adrenal CS patients who were defined as having undergone adrenalectomy, a diagnosis code of CS, and not having pituitary gland surgery.<bold>Main Outcome Measures: </bold>Crude incidence and age-standardized incidence rates, long-term mortality, comorbidities diagnosed preoperatively or developed postoperatively, and the pattern of postoperative glucocorticoid replacement therapy.<bold>Results: </bold>From 2002 to 2017, there were a total of 1199 new adrenal CS patients, including 72 patients with adrenocortical carcinoma (malignant adrenal CS), in Korea. The crude and age-standardized incidence rates were 1.51 and 1.27 per million person-years, respectively. The overall standardized mortality ratio was 3.0 (95% confidence interval [CI], 2.4-3.7) for benign adrenal CS and 13.1 (95% CI, 7.6-18.6) for malignant adrenal CS. Adrenal CS patients had a high risk of having coronary artery disease, stroke, metabolic diseases, and depression. A similar proportion of patients were diagnosed with these comorbidities both preoperatively and postoperatively, suggesting a significant residual risk even after adrenalectomy. The median time of postoperative glucocorticoid replacement therapy was 10.1 months, and the major types of glucocorticoids used were prednisolone (66.6%) and hydrocortisone (22.4%).<bold>Conclusions: </bold>Adrenal CS is associated with multiple comorbidities even after treatment, which necessitates meticulous postoperative care.
- Subjects
SOUTH Korea; COMORBIDITY; CUSHING'S syndrome; EPIDEMIOLOGY; THERAPEUTIC use of glucocorticoids; CUSHING'S syndrome diagnosis; CUSHING'S syndrome treatment; THERAPEUTICS; HORMONES; ADRENALECTOMY; MORTALITY; PROGNOSIS; RETROSPECTIVE studies; DISEASE incidence; CASE-control method; ADRENAL tumors; LONGITUDINAL method; DISEASE complications
- Publication
Journal of Clinical Endocrinology & Metabolism, 2021, Vol 106, Issue 3, pe1362
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/clinem/dgaa752