Guest Rose Marie Posted July 22, 2003 Report Share Posted July 22, 2003 The Journal of Clinical Endocrinology & Metabolism Vol. 86, No. 1 117-123 Copyright ? 2001 by The Endocrine Society -------------------------------------------------------------------------------- Original Studies Incidence and Late Prognosis of Cushing?s Syndrome: A Population-Based Study1 J. Lindholm, S. Juul, J. O. L. J?rgensen, J. Astrup, P. Bjerre, U. Feldt-Rasmussen, C. Hagen, J. J?rgensen, M. Kosteljanetz, L. ?. Kristensen, P. Laurberg, K. Schmidt and J. Weeke Department of Medicine, Holstebro Hospital (J.L.), 7500 Holstebro; Department of Epidemiology and Social Medicine, Aarhus University (S.J.), and Departments of Medicine and Endocrinology (J.O.L.J., J.W.) and Neurosurgery (J.A.), Aarhus University Hospital, 8000 Aarhus; Departments of Neurosurgery (P.B.) and Endocrinology (C.H.), Odense University Hospital, 5000 Odense; Departments of Endocrinology and Neurosurgery (M.K.), Copenhagen University Hospital (U.F.R.), 2100 Copenhagen; Departments of Neurosurgery (J.J.) and Endocrinology (P.L.), Aalborg Hospital, 9000 Aalborg; Department of Medicine and Endocrinology, Herlev University Hospital (L.?.K.), 2730 Herlev; and Department of Neurosurgery, Glostrup University Hospital (K.S.), 2600 Glostrup, Denmark Address all correspondence and requests for reprints to: Dr. J. Lindholm, Department of Medicine, Holstebro Hospital, 7500 Holstebro, Denmark. E-mail: firstname.lastname@example.org. The main purpose was to assess the incidence and late outcome of Cushing?s syndrome, particularly in Cushing?s disease. Information for all patients diagnosed with Cushing?s syndrome during an 11-yr period in Denmark was retrieved. The incidence was 1.2?1.7/million?yr (Cushing?s disease), 0.6/million?yr (adrenal adenoma) and 0.2/million?yr (adrenal carcinoma). Other types of Cushing?s syndrome were rare. In 139 patients with nonmalignant disease, 11.1% had died during follow-up (median, 8.1 yr; range, 3.1?14.0), yielding a standard mortality ratio (SMR) of 3.68 [95% confidence interval (CI), 2.34?5.33]. The SMR was partly attributable to an increased mortality within the first year after diagnosis. Eight patients died before treatment could be undertaken. The prognosis in patients with malignant disease was very poor. Patients in whom more than 5 yr had elapsed since initial surgery were studied separately, including a questionnaire on their perceived quality of health. In 45 patients with Cushing?s disease who had been cured through transsphenoidal neurosurgery, only 1 had died (SMR, 0.31; CI, 0.01?1.72) compared with 6 of 20 patients with persistent hypercortisolism after initial neurosurgery (SMR, 5.06; CI, 1.86?11.0). In patients with adrenal adenoma, SMR was 3.95 (CI, 0.81?11.5). The perceived quality of health was significantly impaired only in patients with Cushing?s disease and appeared independent of disease control or presence of hypopituitarism. It is concluded that 1) Cushing?s syndrome is rare and is associated with increased mortality, in patients with no concurrent malignancy also; 2) the excess mortality was mainly observed during the first year of disease; and 3) the impaired quality of health in long-term survivors of Cushing?s disease is not fully explained. The incidence listed from a paper published from the NIH has Cushings Disease at 2-4 new cases per million per year. I wish they'd get their facts straight. I read on the net that pituitary cushings was 15 cases per million per year today! Acromegaly is 3-4 new cases per million per year and pituitary Cushings is rarer than acromegaly?! "About 30% of pituitary adenomas are lactotroph (prolactin-producing) adenomas. Non-functioning tumors, tumors that do not produce hormones, are nearly as common and account for about 25% of all pituitary adenomas. Somatotroph (growth hormone-producing) adenomas account for 15% to 20% of pituitary adenomas. Corticotroph (ACTH-producing) adenomas represent about 10% to 15% of pituitary adenomas. Gonadotroph adenomas (which produce FSH and/or LH) and thyrotroph adenomas (which produce thyroid-stimulating hormone) each account for a small percentage of pituitary adenomas. Null cell adenomas account for 15 to 20% of pituitary adenomas." http://www.cancer.org/docroot....tearea= Quote Link to comment Share on other sites More sharing options...
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