Cushing's Syndrome in the Elderly: Data from the European Registry on Cushing's Syndrome.
(2023) European journal of endocrinology — Vol. 188, n° 4, p. 395-406 (2023)
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- Authors
Tabarin, Antoine 
Castinetti, Frederic Valassi, Elena
- Abstract
- OBJECTIVE: To evaluate whether age-related differences exist in clinical characteristics, diagnostic approach and management strategies in patients with Cushing's syndrome included in the European Registry on Cushing's Syndrome (ERCUSYN). DESIGN: Cohort study. METHODS: We analyzed 1791 patients with CS, of whom 1234 (69%) had pituitary-dependent CS (PIT-CS), 450 (25%) adrenal-dependent CS (ADR-CS) and 107 (6%) had an ectopic source (ECT-CS). According to the WHO criteria, 1616 patients (90.2%) were classified as younger (<65 years) and 175 (9.8%) as older (>65 years). RESULTS: Older patients were more frequently males and had a lower BMI and waist circumference as compared with the younger. Older patients also had a lower prevalence of skin alterations, depression, hair loss, hirsutism and reduced libido, but a higher prevalence of muscle weakness, diabetes, hypertension, cardiovascular disease, venous thromboembolism and bone fractures than younger patients, regardless of sex (p<0.01 for all comparisons). Measurement of UFC supported the diagnosis of CS less frequently in older patients as compared with the younger (p<0.05). An extra-sellar macroadenoma (macrocorticotropinoma with extrasellar extension) was more common in older PIT-CS patients than in the younger (p<0.01). Older PIT-CS patients more frequently received cortisol-lowering medications and radiotherapy as a first-line treatment, whereas surgery was the preferred approach in the younger (p<0.01 for all comparisons). When transsphenoidal surgery was performed, the remission rate was lower in the elderly as compared with their younger counterpart (p<0.05). CONCLUSIONS: Older CS patients lack several typical symptoms of hypercortisolism, present with more comorbidities regardless of sex, and are more often conservatively treated.
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Citations
Amodru, V., Ferriere, A., Tabarin, A., Castinetti, F., Tsagarakis, S., Toth, M., Feelders, R. A., Webb, S. M., Reincke, M., Netea-Maier, R., Kastelan, D., Elenkova, A., Maiter, D., Ragnarsson, O., Santos, A., & Valassi, E. (2023). Cushing’s Syndrome in the Elderly: Data from the European Registry on Cushing’s Syndrome. European journal of endocrinology, 188(4), 395-406. https://doi.org/10.1093/ejendo/lvad008 (Original work published 2023)