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Mortality and morbidity in Cushing's syndrome in New Zealand
Abstract
OBJECTIVE: Untreated Cushing's syndrome (CS) is associated with significant morbidity and mortality. However, recent operative series suggest low morbidity and mortality for CS, whereas population-based surveys report elevated mortality rates. We investigated the mortality and morbidity of CS in New Zealand. DESIGN: A nationwide retrospective survey of patients with CS between 1960 and 2005 managed at the four main endocrinology services. PATIENTS: A total of 253 patients with CS were identified, excluding adrenal carcinoma and malignant ectopic CS. MEASUREMENTS; The primary outcome was the standardized mortality ratio (SMR), comparing the observed number of deaths with the expected number for the population matched for age, sex and duration of follow-up. Secondary outcomes were the change in prevalence of co-morbidities at presentation and at final follow-up. RESULTS: The approximate prevalence and incidence of CS was 79/million and 1·8/million/y. The mean age at presentation was 39 year, and median duration of follow-up was 6·4 year (range 0-46). Overall, 89% achieved biochemical cure at last follow-up, with >90% achieving biochemical cure for CS from adrenal adenoma and pituitary causes. Thirty-six patients died during follow-up compared with 8·8 expected deaths (SMR 4·1, 95%CI 2·9-5·6). While hypertension, sexual dysfunction, myopathy and mild psychiatric illness were significantly reduced after treatment, hypertension, diabetes mellitus, moderate or major psychiatric illness, and osteoporosis were common at final follow-up. CONCLUSION: CS is associated with both high mortality and a high prevalence of co-morbidities, even when biochemical cure rates are between 80% and 90%.
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“Patients with CS who achieve remission following curative treatment remain at a slightly increased risk of morbidity and mortality compared to patients without CS (27, 28, 113-116).”
From Measuring cortisol in Cushing syndrome: diagnosis, monitoring, and cortisol circadian rhythm improvement. (2026) · cites this paper as [114]
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“This persistent disruption in cortisol circadian rhythm during remission may play a role in the long-term complications associated with prior glucocorticoid excess (28, 113, 114, 116).”
From Measuring cortisol in Cushing syndrome: diagnosis, monitoring, and cortisol circadian rhythm improvement. (2026) · cites this paper as [114]
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Lacroix, A., Feelders, R. A., Stratakis, C. A., & Nieman, L. K. (2015) · The Lancet · doi:10.1016/s0140-6736(14)61375-1 · Cited by 1,777
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Complications of Cushing's syndrome: state of the art
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The Treatment of Cushing's Disease
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Metadata
- Authors
- Bolland, M. J., Holdaway, I. M., Berkeley, J. E., Lim, S., Dransfield, W. J., Conaglen, J. V., Croxson, M. S., Gamble, G. D., Hunt, P. J., & Toomath, R. J.
- Affiliations
- University of Auckland (NZ)
- Greenlane Clinical Centre (NZ)
- Christchurch Hospital (NZ)
- Waikato Hospital (NZ)
- Wellington Hospital (NZ)
- Corresponding author
- Bolland, Mark J.
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2011-09-07
- Volume
- 75
- Issue
- 4
- Pages
- 436-442
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W1526232299
- Cited by
- 182
- References
- 17
- Citations by year
- 2026: 4 · 2025: 13 · 2024: 13 · 2023: 14 · 2022: 21 · 2021: 14 · 2020: 15 · 2019: 15 · 2018: 16 · 2017: 6 · 2016: 8 · 2015: 14 · 2014: 9 · 2013: 9 · 2012: 11
- FWCI
- 7.57
- Type
- journal article
- Language
- en
- Update notices
- correction (2020-06-10)
- Open access
- closed
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Oncology › Neuroendocrine Tumor Research Advances
- Keywords
- Cushing's syndrome, mortality, morbidity, standardized mortality ratio, biochemical cure, adrenal adenoma, pituitary Cushing's disease, comorbidities, hypertension, diabetes mellitus, osteoporosis, mental illness, myopathy, prevalence, New Zealand
- MeSH terms
- Adolescent, Adult, Aged, Child, Child, Preschool, Cushing Syndrome, Female, Humans, Male, Middle Aged, New Zealand, Retrospective Studies, Young Adult
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