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Cited by 134Pituitary Gland Disorders and TreatmentsAdrenal and Paraganglionic TumorsNeuroendocrine Tumor Research Advances

The DOI matches its Crossref record; 8 of the 8 references it cites were found in a registry or an index.

Overall and Disease-Specific Mortality in Patients With Cushing Disease: A Swedish Nationwide Study

Open access
Ragnarsson, Oskar, Olsson, Daniel S, Papakokkinou, Eleni, Chantzichristos, Dimitrios, Dahlqvist, Per, Segerstedt, Elin, Olsson, Tommy, Petersson, Maria, Berinder, Katarina, Bensing, Sophie, Höybye, Charlotte, Edén-Engström, Britt, Burman, Pia, Bonelli, Lorenza, Follin, Cecilia, Petranek, David, Erfurth, Eva Marie, Wahlberg, Jeanette, Ekman, Bertil, Åkerman, Anna-Karin, Schwarcz, Erik, Bryngelsson, Ing-Liss, Johannsson, Gudmundur·2019·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2018-02524
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Abstract

CONTEXT: Whether patients with Cushing disease (CD) in remission have increased mortality is still debatable. OBJECTIVE: To study overall and disease-specific mortality and predictive factors in an unselected nationwide cohort of patients with CD. DESIGN, PATIENTS, AND METHODS: A retrospective study of patients diagnosed with CD, identified in the Swedish National Patient Registry between 1987 and 2013. Medical records were systematically reviewed to verify the diagnosis. Standardized mortality ratios (SMRs) with 95% CIs were calculated and Cox regression models were used to identify predictors of mortality. RESULTS: Of 502 identified patients with CD (n = 387 women; 77%), 419 (83%) were confirmed to be in remission. Mean age at diagnosis was 43 (SD, 16) years and median follow-up was 13 (interquartile range, 6 to 23) years. The observed number of deaths was 133 vs 54 expected, resulting in an overall SMR of 2.5 (95% CI, 2.1 to 2.9). The commonest cause of death was cardiovascular diseases (SMR, 3.3; 95% CI, 2.6 to 4.3). Excess mortality was also found associated with infections and suicide. For patients in remission, the SMR was 1.9 (95% CI, 1.5 to 2.3); bilateral adrenalectomy and glucocorticoid replacement therapy were independently associated with increased mortality, whereas GH replacement was associated with improved outcome. CONCLUSION: Findings from this large nationwide study indicate that patients with CD have excess mortality. The findings illustrate the importance of achieving remission and continued active surveillance, along with adequate hormone replacement and evaluation of cardiovascular risk and mental health.

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Research works printed but not linked: 27

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Metadata

Authors
Ragnarsson, O., Olsson, D. S., Papakokkinou, E., Chantzichristos, D., Dahlqvist, P., Segerstedt, E., Olsson, T., Petersson, M., Berinder, K., Bensing, S., Höybye, C., Edén-Engström, B., Burman, P., Bonelli, L., Follin, C., Petranek, D., Erfurth, E. M., Wahlberg, J., Ekman, B., Åkerman, A.-K., Schwarcz, E., Bryngelsson, I.-L., & Johannsson, G.
Affiliations
  • Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
  • Sahlgrenska University Hospital (SE)
  • Umeå University (SE)
  • Karolinska University Hospital (SE)
  • Department of Medical Sciences; Endocrinology, Diabetes and Metabolism, Uppsala University Hospital, Uppsala, Sweden
  • Skåne University Hospital (SE)
  • Linköping University (SE)
  • Örebro University (SE)
  • Örebro University Hospital (SE)
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2019-02-01
Volume
104
Issue
6
Pages
2375-2384
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2018-02524
OpenAlex
W2914799087
Cited by
134
References
36
Citations by year
2026: 17 · 2025: 17 · 2024: 14 · 2023: 18 · 2022: 29 · 2021: 18 · 2020: 14 · 2019: 7
FWCI
13.84
Type
journal article
Language
en
Open access
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Göteborgs Läkaresällskap
  • Västra Götalandsregionen
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 disease, mortality, remission, cardiovascular disease, suicide, infection, bilateral adrenalectomy, glucocorticoid replacement therapy, growth hormone replacement therapy, hormone replacement therapy, mortality risk factors, active surveillance
MeSH terms
Adult, Cardiovascular Diseases, Female, Humans, Male, Middle Aged, Retrospective Studies, Proportional Hazards Models, Hormone Replacement Therapy, Pituitary ACTH Hypersecretion

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