title: [Comparison of the severity index in Cushing's syndrome between patients with endogenous and iatrogenic disease].
abstract: 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.
authors.affiliation: Medicina Interna y en Endocrinología, Servicio de Endocrinología, Hospital General de México, México. edurandr@gmail.com
authors.forename: Edgar Gerardo Durán
authors.initials: EG
authors.lastname: Pérez
authors.forename: Everardo Alvarez
authors.initials: EA
authors.lastname: Hernández
authors.forename: Aurora Elizabeth Serralde
authors.initials: AE
authors.lastname: Zuñiga
authors.forename: Leslye Asela Lujano
authors.initials: LA
authors.lastname: Nicolás
authors.forename: Oscar Moreno
authors.initials: OM
authors.lastname: Loza
authors.forename: Antonio Segovia
authors.initials: AS
authors.lastname: Palomo
authors.forename: Valentín Sánchez
authors.initials: VS
authors.lastname: Pedraza
authors.forename: Sara Arellano
authors.initials: SA
authors.lastname: Montaño
mesh_terms: 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