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

Abstract EN

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.