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Pia Burman

Physician

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Excess Morbidity Persists in Patients With Cushing's Disease During Long-term Remission : A Swedish Nationwide Study

Author

  • Eleni Papakokkinou
  • Daniel S. Olsson
  • Dimitrios Chantzichristos
  • Per Dahlqvist
  • Elin Segerstedt
  • Tommy Olsson
  • Maria Petersson
  • Katarina Berinder
  • Sophie Bensing
  • Charlotte Höybye
  • Britt Edén-Engström
  • Pia Burman
  • Lorenza Bonelli
  • Cecilia Follin
  • David Petranek
  • Eva Marie Erfurth
  • Jeanette Wahlberg
  • Bertil Ekman
  • Anna Karin Åkerman
  • Erik Schwarcz
  • Ing Liss Bryngelsson
  • Gudmundur Johannsson
  • Oskar Ragnarsson

Summary, in English

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.

Department/s

  • Genomics, Diabetes and Endocrinology

Publishing year

2020

Language

English

Publication/Series

The Journal of clinical endocrinology and metabolism

Volume

105

Issue

8

Document type

Journal article

Publisher

Oxford University Press

Topic

  • Endocrinology and Diabetes

Keywords

  • cardiovascular
  • comorbidity
  • Cushing’s disease
  • remission
  • sepsis
  • thromboembolism

Status

Published

Research group

  • Genomics, Diabetes and Endocrinology

ISBN/ISSN/Other

  • ISSN: 1945-7197