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Excess Morbidity Persists in Patients With Cushing’s Disease During Long-term Remission: A Swedish Nationwide Study
Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; The Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.ORCID iD: 0000-0002-1163-862X
Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; The Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.ORCID iD: 0000-0002-9734-0786
Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; The Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.ORCID iD: 0000-0002-1660-1973
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.ORCID iD: 0000-0002-6471-9503
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2020 (English)In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 105, no 8, p. 2616-2624Article in journal (Refereed) Published
Abstract [en]

Context: Whether multisystem morbidity in Cushing's disease (CD) remains elevated during long-term remission is still undetermined.

Objective: To investigate comorbidities in patients with CD.

Design, setting, and patients: 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.

Main outcomes: 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: (i) during the 3 years before diagnosis, (ii) from diagnosis to 1 year after remission, and (iii) during long-term remission.

Results: 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 (95% CI 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.

Conclusion: 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.

Place, publisher, year, edition, pages
Oxford University Press, 2020. Vol. 105, no 8, p. 2616-2624
Keywords [en]
Cushing’s disease, cardiovascular, comorbidity, remission, sepsis, thromboembolism
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:oru:diva-108764DOI: 10.1210/clinem/dgaa291ISI: 000565927300073PubMedID: 32436951Scopus ID: 2-s2.0-85086792735OAI: oai:DiVA.org:oru-108764DiVA, id: diva2:1802619
Funder
Government of Sweden
Note

Funding Agencies:

county councils, the ALF-agreement

Gothenburg Society of Medicine

Available from: 2023-10-05 Created: 2023-10-05 Last updated: 2023-10-11Bibliographically approved

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Wahlberg, Jeanette

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Papakokkinou, EleniOlsson, Daniel S.Chantzichristos, DimitriosDahlqvist, PerSegerstedt, ElinOlsson, TommyBerinder, KatarinaBensing, SophieHöybye, CharlotteEdén-Engström, BrittBurman, PiaBonelli, LorenzaFollin, CeciliaPetranek, DavidErfurth, Eva MarieWahlberg, JeanetteEkman, BertilÅkerman, Anna-KarinSchwarcz, ErikJohannsson, GudmundurRagnarsson, Oskar
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