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Introduction: A study published at the annual meeting of the American Society of Endocrinology (ENDO) in 2021 shows that although the mortality rate of endogenous Cushing syndrome (CS) patients has declined in the past 20 years, it is still the general population Tripled.
Among them, the deaths due to cerebrovascular, atherosclerotic vascular disease and infection accounted for about 50%.
CS is also called hypercortisolism.
The most common cause is pituitary tumors [Cushing's disease (CD)].
Another common cause is benign adrenal tumors (adrenal CS).
Surgery is the main treatment for CS.
If remission cannot be achieved, medication is usually chosen.
Past data on the mortality of patients with endogenous CS are very limited.
Most of the studies are in a single cohort, and the relevant systematic review/meta analysis only contains 7 articles (n=780), and these studies were conducted before 2012 of.
Therefore, there is currently a lack of new data to assess the prognosis and mortality of patients.
The largest and most extensive study on mortality in Cushing’s syndrome To explore the mortality and causes of death in patients with benign CS, Limumpornpetch and colleagues conducted this study and reviewed 92 studies published from 1952 to January 2021.
Cohort data (n=19,181, 66 studies reported the cause of death).
1.
The mortality rate of CS patients is 3 times that of the general population.
The total mortality rate is 5% in the CS group, 4% in the CD group, and 2% in the adrenal CS group.
After calculation, with reference to the background population, the standardized mortality rate (SMR) of CS patients was 3 (95% CI, 2.
3-3.
9).
Among them, the SMR of adrenal CS patients was 3.
3, which was higher than the 2.
8 of CD patients.
The types of adrenal tumors were analyzed by stratification, and no significant differences were found. In addition, the SMR (5.
7) of patients in the active stage was higher than that of patients in remission (2.
3) (P<0.
001); the SMR of patients with CD and larger tumors was also higher (7.
4), and the SMR of patients with micro tumors was 1.
9 (P=0.
004).
2.
Analysis of causes of death.
Overall, the number of deaths due to atherosclerotic vascular disease accounted for 27.
4% of the total deaths in CS, infection accounted for 12.
7%, cerebrovascular disease accounted for 11.
7%, malignant tumor accounted for 10.
6%, and thromboembolism accounted for 4.
4%, active disease accounted for 2.
9%, adrenal insufficiency accounted for 3%, suicide accounted for 2.
2%.
Compared with 20 years ago, the mortality rate of CS has decreased, but it is still "unacceptable".
Compared with before 2000: ➤The total death rate in the CS group has dropped from 10% to 3%; ➤The total death rate in the CD group has dropped from 14 % Decreased to 3%; ➤The total death rate in the adrenal CS group decreased from 9% to 3%.
➤The proportion of deaths within 30 days after surgery in the CS group decreased from 4% to 1%.
The researchers pointed out that the results of the study seem to reflect the progress in the treatment and care of CS in recent years.
However, the standardized mortality rate of CS patients is still as high as three times that of the general population, which is still an "unacceptable" level.
The prognosis of adrenal CS and CD patients in active stage and with larger tumors is significantly worse.
Reduce perioperative mortality, focusing on the prevention of thromboembolism.
Because Cushing’s disease patients are obese and accompanied by hypercortisolemia, they are prone to hypercoagulable state leading to thrombosis.
There are data showing that patients with CS are more likely to develop venous thromboembolism after surgery.
The crowd is 18 times taller.
A retrospective study conducted by Fleseriu's group showed that the risk of arterial and venous thromboembolic events in CS patients is about 20%, and the risk is particularly high after 30-60 days.
Considering that most of the perioperative deaths of CS patients are caused by venous thromboembolism and infection, the researchers recommend anticoagulation prevention for all CS patients and pay attention to the risk of individual bleeding.
This article summarizes the researchers pointed out that although the mortality rate of CS patients is lower than that before 2000, it is still higher than the general population.
Active management of patients with cardiovascular disease, prevention of thromboembolism, control of infection and maintenance of normal cortisol levels are The key to improving the prognosis.
Reference: Limumpornpetch P.
OR04-4.
Presented at: ENDO annual meeting; March 20-23, 2021 (virtual meeting).
Introduction: A study published at the annual meeting of the American Society of Endocrinology (ENDO) in 2021 shows that although the mortality rate of endogenous Cushing syndrome (CS) patients has declined in the past 20 years, it is still the general population Tripled.
Among them, the deaths due to cerebrovascular, atherosclerotic vascular disease and infection accounted for about 50%.
CS is also called hypercortisolism.
The most common cause is pituitary tumors [Cushing's disease (CD)].
Another common cause is benign adrenal tumors (adrenal CS).
Surgery is the main treatment for CS.
If remission cannot be achieved, medication is usually chosen.
Past data on the mortality of patients with endogenous CS are very limited.
Most of the studies are in a single cohort, and the relevant systematic review/meta analysis only contains 7 articles (n=780), and these studies were conducted before 2012 of.
Therefore, there is currently a lack of new data to assess the prognosis and mortality of patients.
The largest and most extensive study on mortality in Cushing’s syndrome To explore the mortality and causes of death in patients with benign CS, Limumpornpetch and colleagues conducted this study and reviewed 92 studies published from 1952 to January 2021.
Cohort data (n=19,181, 66 studies reported the cause of death).
1.
The mortality rate of CS patients is 3 times that of the general population.
The total mortality rate is 5% in the CS group, 4% in the CD group, and 2% in the adrenal CS group.
After calculation, with reference to the background population, the standardized mortality rate (SMR) of CS patients was 3 (95% CI, 2.
3-3.
9).
Among them, the SMR of adrenal CS patients was 3.
3, which was higher than the 2.
8 of CD patients.
The types of adrenal tumors were analyzed by stratification, and no significant differences were found. In addition, the SMR (5.
7) of patients in the active stage was higher than that of patients in remission (2.
3) (P<0.
001); the SMR of patients with CD and larger tumors was also higher (7.
4), and the SMR of patients with micro tumors was 1.
9 (P=0.
004).
2.
Analysis of causes of death.
Overall, the number of deaths due to atherosclerotic vascular disease accounted for 27.
4% of the total deaths in CS, infection accounted for 12.
7%, cerebrovascular disease accounted for 11.
7%, malignant tumor accounted for 10.
6%, and thromboembolism accounted for 4.
4%, active disease accounted for 2.
9%, adrenal insufficiency accounted for 3%, suicide accounted for 2.
2%.
Compared with 20 years ago, the mortality rate of CS has decreased, but it is still "unacceptable".
Compared with before 2000: ➤The total death rate in the CS group has dropped from 10% to 3%; ➤The total death rate in the CD group has dropped from 14 % Decreased to 3%; ➤The total death rate in the adrenal CS group decreased from 9% to 3%.
➤The proportion of deaths within 30 days after surgery in the CS group decreased from 4% to 1%.
The researchers pointed out that the results of the study seem to reflect the progress in the treatment and care of CS in recent years.
However, the standardized mortality rate of CS patients is still as high as three times that of the general population, which is still an "unacceptable" level.
The prognosis of adrenal CS and CD patients in active stage and with larger tumors is significantly worse.
Reduce perioperative mortality, focusing on the prevention of thromboembolism.
Because Cushing’s disease patients are obese and accompanied by hypercortisolemia, they are prone to hypercoagulable state leading to thrombosis.
There are data showing that patients with CS are more likely to develop venous thromboembolism after surgery.
The crowd is 18 times taller.
A retrospective study conducted by Fleseriu's group showed that the risk of arterial and venous thromboembolic events in CS patients is about 20%, and the risk is particularly high after 30-60 days.
Considering that most of the perioperative deaths of CS patients are caused by venous thromboembolism and infection, the researchers recommend anticoagulation prevention for all CS patients and pay attention to the risk of individual bleeding.
This article summarizes the researchers pointed out that although the mortality rate of CS patients is lower than that before 2000, it is still higher than the general population.
Active management of patients with cardiovascular disease, prevention of thromboembolism, control of infection and maintenance of normal cortisol levels are The key to improving the prognosis.
Reference: Limumpornpetch P.
OR04-4.
Presented at: ENDO annual meeting; March 20-23, 2021 (virtual meeting).
