Cushing's disease in older patients: Presentation and outcome

Clin Endocrinol (Oxf). 2018 Oct;89(4):444-453. doi: 10.1111/cen.13799. Epub 2018 Jul 16.

Abstract

Background: To define the symptoms, signs and treatment outcomes in a population of older patients with Cushing's disease (CD).

Methods: We analysed the clinical presentation and treatment outcomes in 45 CD patients older than 60 years, in comparison with 90 CD patients younger than 60, and a control group of 45 older patients with nonfunctioning pituitary adenomas. We reviewed preoperative clinical characteristics, medical comorbidities, imaging findings and endocrine testing as well as surgical and endocrine outcomes.

Results: Older CD patients had significantly lower body mass index (BMI) (P = 0.031), were more likely to have muscle wasting (P = 0.006) and women were less likely to have hirsutism (P = 0.033). Older patients with CD had more medical comorbidities than younger patients, which correlated with a higher ASA grade (P < 0.001), but the surgical complication rates were similar in both groups. Surgical remission was achieved in 38/45 (84.4%) older patients and 78/90 (86.7%) younger patients (P = NS). Recurrent disease was more frequent in younger patients (19.2%) in comparison with older patients (2.6%, P = 0.019).

Conclusions: Older patients with CD appear to have a distinct phenotype with a more catabolic picture, including a lower BMI and greater prevalence of muscle wasting. Surgical outcomes are similar without a significant age-related increase in complications.

Keywords: ACTH-secreting pituitary adenoma; Cushing's disease; recurrence; remission; transsphenoidal surgery.

MeSH terms

  • Aged
  • Body Mass Index
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Pituitary ACTH Hypersecretion / blood
  • Pituitary ACTH Hypersecretion / diagnosis*
  • Pituitary ACTH Hypersecretion / surgery
  • Pituitary Neoplasms / blood
  • Pituitary Neoplasms / diagnosis
  • Pituitary Neoplasms / surgery
  • Postoperative Complications