[Comparison of the severity index in Cushing's syndrome between patients with endogenous and iatrogenic disease].
Cushing's syndrome (CS) is a rare condition that is most often secondary to glucocorticoid (GC) intake. Definitive data on the distinction between endogenous CS (ECS) and yatrogenic (YCS) have not been published.


OBJECTIVE
To compare the severity index in Cushing's syndrome (SICS) score in the two etiologies, endogenous and yatrogenic, and identify which clinical parameters of the SICS are the most frequent and representative of CS.


METHODS
We performed an observational, descriptive and cross-sectional study. The ECS group included men and women with a diagnosis of endogenous hypercortisolism, with measurement of adrenocorticotropin hormone (ACTH) and absence of causes of pseudo-Cushing's syndrome. The YCS group included patients with a history of use of high-dose systemic GC, cushingoid facies, absence of causes of pseudo-Cushing's syndrome and no diagnosis of hypertension or diabetes mellitus before the start of GC intake. We investigated the diagnosis of the disease entity causing ECS. In patients with ICS, the characteristics of the GC employed and how these drugs were used were recorded. We calculated daily and cumulative doses in milligrams of prednisone. In all patients, the SICS was applied and the clinical characteristics of the two groups were compared.


RESULTS
We included 20 patients, 10 with YCS and 10 with ECS. There were eight women in the ECS group (80%) and five in the YCS group (50%). The diagnoses in patients with ECS were ACTH-dependent CS in nine and ACTH-independent CS in one. The mean daily dose of prednisone equivalent used by patients with YCS was 13.5mg, and the mean total cumulative dose for all patients with ICS was 9962.5mg. The mean total SICS score for the ECS group was 8.6 and was 3.8 points for the YCS group (p <0.005, 95% CI 3.36-6.23). All patients with ECS had a mean score of 6 or higher whereas none of the patients with ICS scored more than 6 points. Fat distribution, hypertension, diabetes mellitus and gender-related changes were more representative of patients with ECS.


CONCLUSIONS
SICS scores were higher patients with ECS than in those with ICS. The clinical differences between the two groups may be important.
Pérez
Edgar Gerardo Durán
EG
Medicina Interna y en Endocrinología, Servicio de Endocrinología, Hospital General de México, México. edurandr@gmail.com
Hernández
Everardo Alvarez
EA
Zuñiga
Aurora Elizabeth Serralde
AE
Nicolás
Leslye Asela Lujano
LA
Loza
Oscar Moreno
OM
Palomo
Antonio Segovia
AS
Pedraza
Valentín Sánchez
VS
Montaño
Sara Arellano
SA
D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D055815:Young Adult