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Time to diagnosis in Cushing's syndrome: a meta-analysis based on 5367 patients
Open accessAbstract
Context: Signs and symptoms of Cushing’s syndrome (CS) overlap with common diseases, such as the metabolic syndrome, obesity, osteoporosis, and depression. Therefore, it can take years to finally diagnose CS, although early diagnosis is important for prevention of complications. Objective: The aim of this study was to assess the time span between first symptoms and diagnosis of CS in different populations to identify factors associated with an early diagnosis. Data Sources: A systematic literature search via PubMed was performed to identify studies reporting on time to diagnosis in CS. In addition, unpublished data from patients of our tertiary care center and 4 other centers were included. Study Selection: Clinical studies reporting on the time to diagnosis of CS were eligible. Corresponding authors were contacted to obtain additional information relevant to the research question. Data Extraction: Data were extracted from the text of the retrieved articles and from additional information provided by authors contacted successfully. From initially 3326 screened studies 44 were included. Data Synthesis: Mean time to diagnosis for patients with CS was 34 months (ectopic CS: 14 months; adrenal CS: 30 months; and pituitary CS: 38 months; P < .001). No difference was found for gender, age (<18 and ≥18 years), and year of diagnosis (before and after 2000). Patients with pituitary CS had a longer time to diagnosis in Germany than elsewhere. Conclusions: Time to diagnosis differs for subtypes of CS but not for gender and age. Time to diagnosis remains to be long and requires to be improved.
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“These challenges often lead to delayed diagnosis, contributing to increased morbidity and mortality (48-50, 53).”
From Measuring cortisol in Cushing syndrome: diagnosis, monitoring, and cortisol circadian rhythm improvement. (2026) · cites this paper as [50]
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“The diagnosis of endogenous CS can be challenging due to overlap with common conditions, highly variable clinical features, and challenges in appropriately interpreting biochemical screening and diagnostic tests (11, 48-52).”
From Measuring cortisol in Cushing syndrome: diagnosis, monitoring, and cortisol circadian rhythm improvement. (2026) · cites this paper as [50]
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- Rubinstein, 2019. . : 10.5282//.153, Time to diagnosis in Cushing’s syndrome: a meta-analysis based on 5367 patients. · DOI
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“As a result, time elapsed to diagnosis can be considerably large, increasing the burden of the disease and contributing to maintain multiple comorbidities, poor quality of life (QoL) and reduced life expectancy even after long-term resolution of hormone excess.(2,4) The European Registry on Cushing's syndrome (ERCUSYN…”
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“Cushing syndrome (CS) is a rare condition (1) that is often diagnosed late in the course of disease, often years after the first onset of symptoms (2).”
Self-citationAcute and Life-threatening Complications in Cushing Syndrome: Prevalence, Predictors, and Mortality
Schernthaner-Reiter, M. H., Siess, C., Micko, A. S. G., Zauner, C., Wolfsberger, S., Scheuba, C., Riss, P., Knosp, E., Kautzky‐Willer, A., Luger, A., et al. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgab058 · Cited by 55
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Balomenaki, M., Margaritopoulos, D., Vassiliadi, D. A., & Tsagarakis, S. (2022) · Journal of Neuroendocrinology · doi:10.1111/jne.13111 · Cited by 41
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“This is best understood in the context of the correct ways to achieve a complete 24-h collection: (1) The patient wakes up and discards the first voided urine; all subsequent voids are collected until waking at the same time the next day, at which time the waking void is collected, or (2) the collection is started at…”
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“Moreover, the signs and symptoms of Cushing’s syndrome caused by glucocorticoids have a range of systemic and local effects on bone and mineral metabolism that overlap with common diseases, such as metabolic syndrome, obesity, and osteoporosis [68].”
BackgroundCharacteristics and outcomes of the Finnish ectopic ACTH syndrome cohort
Toivanen, S., Leijon, H., Arola, A., Soinio, M., Hämäläinen, P., Metso, S., Knutar, O., Koivikko, M. L., Ebeling, T., Moilanen, L., et al. (2021) · Endocrine · doi:10.1007/s12020-021-02768-0 · Cited by 25
“In our study, SCLC was diagnosed in 15% of cases, in line with previous reports.”
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“The average time to diagnosis of Cushing’s disease (CD) is 38 months [1].”
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“Delayed diagnosis is a recognized problem [24], and it is suspected that several children with CS actually have had this condition from childhood, but remain undiagnosed until adulthood.”
BackgroundSelf-citationBlew, K., Mater, D. V., & PAGE, L. C. (2023) · JCEM Case Reports · doi:10.1210/jcemcr/luad101 · Cited by 13
“Delayed diagnosis is common in ectopic ACTH secretion causing CS, with a mean time to diagnosis of 14 months [5].”
BackgroundWhite blood cell count: a valuable tool for suspecting Cushing’s syndrome
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Self-citationLack of sensitivity of diagnostic Cushing-scores in Germany: a multicenter validation
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“…contributing to the maintenance of comorbidities, poor Qol and short life expectancy, even after long-term clearance of excess hormone levels [20,21]. in our study, individuals with VFs exhibited a 1.5-fold longer median presumed disease duration than those without VFs. although not…”
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“…ti ng do s e s ( 1500 – 2500 m g d a il y ) h a v e b ee n u s e d i n t h e t r ea t m e n t o f i n t e n s e hyp e r c o r ti s o li s m [ 54 , 6 4 , 65 ] 45– 100 % r e m i ss i on r a t e s i n C D r e po r t e d w it h m ea n 71 % [ 56 ] , 66 % c on t r o l i n a m e t a - a n a l y s i s […”
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Effects of metyrapone in patients with mild hypercortisolism
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“…fi ciency (PAI) with either an inborn lack of cortisol but maintained adrenal androgen synthesis in congenital adrenal hyperplasia (CAH) versus complete loss of adrenal function over time due to an autoimmune disorder in Addison ’ s disease (AD) or abruptly due to bilateral adrenalectomy (1, 2).”
BackgroundSelf-citationThyroid function spectrum in Cushing’s syndrome
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“We performed this analysis as previously reported [8].”
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“[21] This delay is due to both the non-specificity of hypercortisolism symptoms/ signs and the complexity of screening tests (UFC, late-night salivary and serum cortisol, and low-dose DSTs).”
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“The time to diagnosis in both adrenal CS and CD often exceeds 30 months, typically based on clinical suspicion or patient-reported symptoms [36].”
Cushing Syndrome due to a Pancreatic Neuroendocrine Tumor Treated With Radiofrequency Ablation
Sideri, A., Fang, J., Visrodia, K., & Page‐Wilson, G. (2023) · JCEM Case Reports · doi:10.1210/jcemcr/luad022 · Cited by 6
“…adrenocorticotropic hormone (ACTH)-dependent, arising from corticotroph pituitary adenomas (Cushing disease), and less frequently from ectopic neuroendocrine tumors including thymic, pancreatic, and bronchial carcinoids; pheochromocytomas; and medullary thyroid and small cell lung carcinomas [1].”
BackgroundDery, L., Stern, J., Shimon, I., Rudman, Y., Kushnir, S., Shochat, T., Fleseriu, M., & Akirov, A. (2024) · Pituitary · doi:10.1007/s11102-024-01399-8 · Cited by 6
“This aligns with a meta-analysis that has identified a shorter time to diagnose aCS compared to CD, although the result was not significant [34].”
Biochemical Control in Cushing's Syndrome: Outcomes of the Treatment in a Large Single Center Cohort
Ritzel, K., Fazel, J., August, L., Fedtke, V., Nowak, E., Vogel, F., Braun, L., Zopp, S., Then, C., Kunzel, H. E., et al. (2024) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgae337 · Cited by 7
Self-citationScreening of hypercortisolism among patients with hypertension: an Italian nationwide survey
Dalmazi, G. D., Goi, J., Burrello, J., Tucci, L., Cicero, A. F. G., Mancusi, C., Moia, E. C., Iaccarino, G., Borghi, C., Muiesan, M. L., et al. (2024) · Journal of Endocrinological Investigation · doi:10.1007/s40618-024-02387-2 · Cited by 6
An Update on the Genetic Drivers of Corticotroph Tumorigenesis
Hernández-Ramírez, L. C., Perez‐Rivas, L. G., Theodoropoulou, M., & Korbonits, M. (2024) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/a-2337-2265 · Cited by 6
“The untreated CD is associated with higher morbidity and mortality, and therefore, timely diagnosis and efficient treatment are critical [2–5]; diagnosis is delayed by an average of 3.2 years [6].”
BackgroundInfluentialPatient reported outcomes and treatment satisfaction in patients with cushing syndrome
Rakovec, M., Zhu, W., Khalafallah, A. M., Salvatori, R., Hamrahian, A. H., Gallia, G. L., Ishii, M., London, N. R., Ramanathan, M., Rowan, N. R., et al. (2022) · Endocrine · doi:10.1007/s12020-022-03214-5 · Cited by 6
“reported a mean overall time to diagnosis of 34 months (95% confidence interval 30–38) [30].”
BackgroundCushing's Syndrome in the Elderly
Zdrojowy-Wełna, A., & Valassi, E. (2024) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/a-2317-8821 · Cited by 7
“In particular, CS may be misdiagnosed with metabolic syndrome, especially in the first phas - es of the disease, leading to a mean delay in diagnosis of about three years, also influenced by the rarity of the condition (estimat - ed incidence 0.2–5/1000 000 per year) [3, 4].”
BackgroundInfluentialSelf-citationObesity care in Chinese adults: from evidence to clinical practice
An, J., Jia, Q., Huang, Y., Cao, Y., Duan, Y., Zhang, H., & Li, S. (2025) · Precision Clinical Medicine · doi:10.1093/pcmedi/pbaf036 · Cited by 8
“For example, the median time to initial diagnosis of Cushing syndrome is 34 months from the symptom onset [ 33 ].”
Plutzky, J., Taub, P. R., Bhatt, D. L., Dhaybi, O. A., Aroda, V. R., BASILE, J. N., Bloch, M. J., Budoff, M. J., Busch, R. S., Buse, J. B., et al. (2026) · JACC Advances · doi:10.1016/j.jacadv.2026.102596 · Cited by 6
The molecular genetics of adrenal cushing
Vaduva, P., & Bertherat, J. Y. (2024) · HORMONES · doi:10.1007/s42000-024-00608-0 · Cited by 5
“Mortality is also high in adrenocortical carcinoma, but mainly due to tumor growth and metastasis [9].”
Socio-Economic Consequences of Cushing's Syndrome: A Nationwide Cohort StudyPreprint
Ebbehøj, A. L., Søndergaard, E., Jepsen, P., Stochholm, K., Svane, H. M. L., Madsen, M., Poulsen, P. L., & Jørgensen, J. O. L. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4000566 · Cited by 5
Changes in clinical features of adrenal Cushing syndrome: a national registry study
Katabami, T., Asai, S., Matsuba, R., Sone, M., Izawa, S., Ichijo, T., Tsuiki, M., Okamura, S., Yoshimoto, T., Otsuki, M., et al. (2025) · Endocrine Connections · doi:10.1530/ec-24-0684 · Cited by 4
“However, in most studies from other countries, adrenal CS accounts for a smaller proportion of all CS cases compared to Japan (20 – 47 vs >50%, respectively), despite a rise in incidence in recent reports (10, 13, 14, 15, 16).”
Clinical Practice Patterns in Bone Health Assessment and Management in Endogenous Cushing's Syndrome
Behary, P., Raveendran, D., Nair, R., Marco, A. D., Papadopoulou, D. A., Wernig, F., Abbara, A., Meeran, K. M., Martin, N. M., Cox, J., et al. (2025) · Clinical Endocrinology · doi:10.1111/cen.70085 · Cited by 4
Resistant hypertension, hyperaldosteronism, and the emerging understanding of hypercortisolism
EINHORN, D. F., Mende, C. W., & Auchus, R. J. (2026) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000001315 · Cited by 4
Hepşen, S., Gul, U., Bostan, H., Akhanlı, P., Sencar, M. E., Kızılgül, M., Ünsal, İ. Ö., & Çakal, E. (2024) · International Journal of Obesity · doi:10.1038/s41366-024-01598-0 · Cited by 4
“Frequently, the diagnosis of this condition is delayed until clinical signs and symptoms become more pronounced, often resulting in the emergence of signi fi cant comorbidities by that time [2].”
BackgroundThe Evolution of Our Understanding of the Nuances of Pathologic Cortisol Secretion
Blevins, L. S. (2025) · Endocrine Practice · doi:10.1016/j.eprac.2025.06.002 · Cited by 4
Cushing Mortality in Remission: Not Out of the Woods
Kelsall, A., & Newell-Price, J. D. C. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac341 · Cited by 4
“On the other hand, against this notion is that the time to diagnosis for patients with adrenal Cushing appears to be significantly less than those with pituitary disease (30 months vs 38 months) (8).”
BackgroundLam-Chung, C., & Ramos, D. C. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.1075785 · Cited by 4
“Moreover, the time taken to diagnose CS differs according to its subtypes and geographic regions (27).”
BackgroundMethodInfluentialGutiérrez, C. G., Saavedra-Vasquez, M. A., Corrales, E. P., Berrocal, V. R., Luque‐Ramírez, M., & Castro, M. A. (2025) · Annales d Endocrinologie · doi:10.1016/j.ando.2025.101802 · Cited by 3
Venous thromboembolism in patients with pituitary adenoma: UK multicentre cohort study
Isand, K., Pofi, R., Härmson, O., Vergis, M., Mahendran, H., Ayuk, J., Wass, J. A. H., Yajnik, P., Bradley, K., Karavitaki, N., et al. (2025) · European Journal of Endocrinology · doi:10.1093/ejendo/lvaf139 · Cited by 3
Takenouchi, H., Anno, T., Iwamoto, H., Takahashi, K., Iwamoto, Y., Horiya, M., Kimura, Y., Kawasaki, F., Kaku, K., Tomoda, K., et al. (2022) · Internal Medicine · doi:10.2169/internalmedicine.8665-21 · Cited by 3
“Since it takes longer to diagnose Cushing’s disease than adrenal Cushing’s syndrome, we should pay closer attention to signs and symptoms of pituitary Cushing’s syndrome overlapping with common diseases (21).”
BackgroundBlasco, L. G., Corrales, P. J. P., Hanzu, F. A., Martínez, A. F., Lesmes, I. B., & Escalada, J. (2023) · Endocrinología Diabetes y Nutrición · doi:10.1016/j.endinu.2023.01.005 · Cited by 3
Self-citationPituitary apoplexy in cushing’s disease: a single center study and systematic literature review
Ragate, D. C., Memon, S. S., Sarathi, V., Lila, A. R., Channaiah, C. Y., Patil, V. A., Karlekar, M. P., Barnabas, R., Thakkar, H. U., Shah, N. S., et al. (2024) · Pituitary · doi:10.1007/s11102-024-01411-1 · Cited by 3
“A delay in diagnosis of CD (mean 38 months) due to its rarity and overlap of its presentation with metabolic syndrome have been reported in a meta-analysis of Cushing’s syndrome [50].”
Higher risk and earlier onset glaucoma in Cushing's syndrome
Sharon, Y., Shochat, T., Rudman, Y., Kushnir, S., Zahavi, A., Shimon, I., Fleseriu, M., & Akirov, A. (2024) · Acta Ophthalmologica · doi:10.1111/aos.16787 · Cited by 3
“This observation, coupled with the well-documented diagnostic delay of CS (Rubinstein et al., 2020), suggests that the hypercortisolism before the formal diagnosis of CS did put them at a heightened risk of developing glaucoma at a younger age.”
Systematic approach to the diagnosis and management of endocrine hypertension
Stowasser, M., Jansen, P. M., & Wolley, M. J. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-96120-2.00009-1 · Cited by 4
Hamidi, O., St-Jean, M., Lacroix, A., & Bancos, I. (2026) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgag095 · Cited by 5
Ectopic ACTH Syndrome: Possibilities of Modern Diagnostics
Grineva, E. N., Tsoy, U. A., & Рыжкова, Д. В. (2024) · Annals of the Russian academy of medical sciences · doi:10.15690/vramn12677 · Cited by 2
Bryk, A. H., Minasyan, M., Hubalewska–Dydejczyk, A., & Gilis‐Januszewska, A. (2024) · Endocrine Connections · doi:10.1530/ec-23-0557 · Cited by 3
“Since the time to CS diagnosis is delayed (34), we categorized VTE which occurred prior to the initiation of endocrinological work-up as VTE during active hypercortisolemia.”
BackgroundChanging face of Cushing’s disease over three decades in pituitary center
Muradov, İ., Şahin, S., Uysal, S., Sulu, C., Gunebakan, P., Tunc, A., Kocaman, B. B., Soltanova, L., Gazioğlu, N., Tanrıöver, N., et al. (2025) · Journal of Endocrinological Investigation · doi:10.1007/s40618-025-02702-5 · Cited by 3
Clinical management of ectopic Cushing Syndrome in neuroendocrine neoplasms: a national survey
Laffi, A., Prinzi, A., di Dato, C., Feola, T., Medici, M., Colao, A., Faggiano, A., & Lania, A. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1690837 · Cited by 2
Twist of endocrine scenario: Approach of ectopic Cushing syndrome (review)
Morar, A., Ghemigian, A. M., Ţupea, C., Petrova, E. N., Popescu, M. R., Carşote, M., Dumitru, N., & Valea, A. (2020) · Romanian Journal of Medical Practice · doi:10.37897/rjmp.2020.4.7 · Cited by 2
Blasco, L. G., Corrales, P. J. P., Hanzu, F. A., Martínez, A. F., Lesmes, I. B., & Martín, J. E. S. (2023) · Endocrinología Diabetes y Nutrición (English ed ) · doi:10.1016/j.endien.2023.04.004 · Cited by 2
Self-citationAbordagem geral das características da Síndrome de Cushing
Weksler, F. L., Weksler, G. L., Portela, M. V. M., Nobre, C. F. A., & de Siqueira, E. C. (2023) · Revista Eletrônica Acervo Saúde · doi:10.25248/reas.e12852.2023 · Cited by 2
Balderrama-Soto, A., Rivera-Hernández, A. D. J., Reza-Albarrán, A. A., la Vega, A. N.-D., Vergara-López, A., Monteros-Sánchez, A. L. E. D. L., Navas-Minero, C. E., Abreu-Rosario, C., Cuevas-Ramos, D., Espinosa-Cárdenas, E., et al. (2023) · Revista Mexicana de Endocrinología Metabolismo y Nutrición · doi:10.24875/rme.m23000025 · Cited by 2
Sawamura, T., Kometani, M., Karashima, S., & Yoneda, T. (2024) · BMJ Case Reports · doi:10.1136/bcr-2024-259687 · Cited by 2
Trummer, C., Pandis, M., Theiler‐Schwetz, V., Schmitt, L., Obermayer-Pietsch, B. M., Gellner, V., Simon, A., & Pilz, S. (2024) · Endocrine · doi:10.1007/s12020-024-03832-1 · Cited by 2
“Even though rapid treatment induction is of utmost priority in CS, time to diagnosis is often signi fi cantly delayed [6 – 8].”
BackgroundPredictors of cancer in patients with endogenous Cushing’s syndrome
Rudman, Y., Drozdinsky, G., Masri‐Iraqi, H., Shochat, T., Kushnir, S., Shimon, I., Fleseriu, M., & Akirov, A. (2025) · Endocrine Related Cancer · doi:10.1530/erc-25-0059 · Cited by 2
Salvio, G., Ciarloni, A., Aboud, N., Ambo, N., Bordoni, M., Lucchetti, B., Martino, M., Perrone, M., Gasparroni, M., Balercia, G., et al. (2025) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaf681 · Cited by 2
Metformin: the white knight fighting corticosteroid side-effects
Reincke, M. (2020) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(20)30040-1 · Cited by 2
Self-citationEncuesta sobre la docencia pregrado de Endocrinología y Nutrición en España-2021
Pinés-Corrales, P. J., Hanzu, F. A., Fernández, R. C., Martínez, A. F., Pérez, C. T., Escalada, J., & Lesmes, I. B. (2022) · Endocrinología Diabetes y Nutrición · doi:10.1016/j.endinu.2022.05.005 · Cited by 2
Self-citationACTH-dependent Cushing's syndrome
Fernandes, S., Varlamov, E. V., & Fleseriu, M. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-96120-2.00011-x · Cited by 2
Abreu-Lomba, A., Rojas, W., Perlaza, F. G., Tovar, H., Tovar, A. P., Syro, L. V., Gutiérrez-Restrepo, J., Román-Gonzaléz, A., Melo, L. J. R., & Rodríguez, N. G. (2023) · Revista Colombiana de Endocrinología Diabetes & Metabolismo · doi:10.53853/encr.10.3.823 · Cited by 2
“[25] Rubinstein G, Osswald A, Hoster E, Losa M, Elenkova A, Zacharieva S, et al.”
BackgroundQiu, Y., Zhao, H., Pan, H., Guo, L., Du, S., Qiu, M., Wu, C., Han, J., Zhang, X., Zhou, Z., et al. (2022) · Annals of Palliative Medicine · doi:10.21037/apm-22-1177 · Cited by 1
Díez, J. J., Anda, E., Lesmes, I. B., González, C., Miguélez, M., Zugasti, A., & Fernández, A. (2025) · Endocrinología Diabetes y Nutrición (English ed ) · doi:10.1016/j.endien.2025.101531 · Cited by 1
A Corticotropin-Secreting Adenoma in the Setting of von Hippel-Lindau Disease
Chen, X., Zhou, Y., Lü, L., Feng, M., Wang, L., & Tong, A. (2025) · JCEM Case Reports · doi:10.1210/jcemcr/luaf055 · Cited by 1
“Diagnosis of Cushing disease is frequently delayed for several years, partly due to insufficient awareness of the insidious and progressive nature of the disease, as well as the complexity involved in testing [19, 20].”
Szklarz, M., Gontarz-Nowak, K., Górny, J. M., & Matuszewski, W. (2025) · SN Comprehensive Clinical Medicine · doi:10.1007/s42399-025-01994-1 · Cited by 1
“In the past, SCLCs accounted for the vast majority of cases [8].”
Metadata
- Authors
- Rubinstein, G., Osswald, A., Hoster, E., Losa, M., Elenkova, A., Zacharieva, S., Machado, M. C., Hanzu, F. A., Zopp, S., Ritzel, K., Riester, A., Braun, L. T., Kreitschmann-Andermahr, I., Storr, H. L., Bansal, P., Barahona, M.-J., Cosaro, E., Dogansen, S. C., Johnston, P. C., Santos de Oliveira, R., Raftopoulos, C., Scaroni, C., Valassi, E., van der Werff, S. J. A., Schopohl, J., Beuschlein, F., & Reincke, M.
- Affiliations
- LMU Klinikum (DE)
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (DE)
- Vita-Salute San Raffaele University (IT)
- Medical University of Sofia (BG)
- Universidade de São Paulo (BR)
- Hospital Clínic de Barcelona (ES)
- Neurochirurgische Klinik, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
- Queen Mary University of London (GB)
- King Edward Memorial Hospital and Seth G.S. Medical College (IN)
- University Hospital Mútua de Terrassa (ES)
- University of Verona (IT)
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey
- Royal Victoria Hospital (GB)
- Division of Pediatric Neurosurgery of the Department of Surgery and Anatomy, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- UCLouvain (BE)
- University of Padua (IT)
- Universitat Autònoma de Barcelona (ES)
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
- ORCID
- Rubinstein, German
- Osswald, Andrea
- Hoster, Eva
- Losa, Marco
- Elenkova, Atanaska
- Zacharieva, Sabina
- Machado, Márcio Carlos
- Hanzu, Felicia Alexandra
- Zopp, Stephanie
- Ritzel, Katrin
- Riester, Anna
- Braun, Leah Theresa
- Storr, Helen L
- Barahona, María-José
- Johnston, Philip C
- Raftopoulos, Christian
- Scaroni, Carla
- Valassi, Elena
- Schopohl, Jochen
- Beuschlein, Felix
- Reincke, Martin
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2019-10-29
- Volume
- 105
- Issue
- 3
- Pages
- e12-e22
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2949356757
- Semantic Scholar
- 76b4317201b4458ff9a1ddd19101a38655092f73
- Cited by
- 180
- References
- 66
- Citations by year
- 2026: 29 · 2025: 31 · 2024: 30 · 2023: 25 · 2022: 28 · 2021: 17 · 2020: 16 · 2019: 2
- FWCI
- 2.43
- Type
- journal article
- Language
- en
- Open access
- green
- www.zora.uzh.ch
- Licence
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion, other-oa)
- DIAL (Catholic University of Leuven) (submittedVersion, other-oa)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- Else Kröner-Fresenius Stiftung (2012_A103, 2015_A228)
- Deutsche Forschungsgemeinschaft (314061271-TRR 205)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- Cushing's syndrome, time to diagnosis, delayed diagnosis, ectopic ACTH syndrome, adrenal Cushing's syndrome, early diagnosis
- MeSH terms
- Age Factors, Cushing Syndrome, Humans, Sex Factors, Time Factors, Early Diagnosis, Delayed Diagnosis
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