title: Mortality in Cushing's syndrome: a systematic review and meta-analysis.
abstract: BACKGROUND
  Data on mortality associated with Cushing's disease (CD) and Cushing's syndrome (CS) are scarce.
  
  
  OBJECTIVE
  To perform a systematic review and meta-analysis of mortality studies in patients with CD and CS secondary to a benign adrenal adenoma.
  
  
  METHODS
  A search was performed in seven electronic databases. Sixty-six articles were retrieved for analysis and 7 included in the final study. The main outcome measure was standardized mortality ratio (SMR).
  
  
  METHODS
  Studies reporting SMR for patients diagnosed with CD and/or CS. Outcomes were stratified by subtype of Cushing's syndrome.
  
  
  METHODS
  Studies were appraised by two authors and were synthesized using a weighted estimate based on the standard error of the SMR.
  
  
  RESULTS
  The weighted mean of SMR for patients with CD was 1.84 (95% confidence interval (CI): 1.28-2.65). CD patients with persistent disease after initial surgery had a SMR of 3.73 (95% CI: 2.31-6.01), whereas mortality of CD patients with initial remission did not differ significantly from the general population (SMR: 1.23 (95% CI: 0.51-2.97)). SMR for patients with a benign adrenal adenoma was 1.90 (95% CI: 0.93-3.91). Age, sex and observation time did not significantly impact mortality.
  
  
  CONCLUSIONS
  CD as opposed to CS due to a benign adrenal adenoma is associated with an excess mortality, which is attributed to patients in whom initial surgical cure is not obtained. This underlines the importance of a rigorous and early follow-up of newly operated patients with CD.
authors.affiliation: Department of Endocrinology and Internal Medicine (MEA), Aarhus University Hospital, Aarhus, Denmark.
authors.forename: D
authors.initials: D
authors.lastname: Graversen
authors.forename: P
authors.initials: P
authors.lastname: Vestergaard
authors.forename: K
authors.initials: K
authors.lastname: Stochholm
authors.forename: C H
authors.initials: CH
authors.lastname: Gravholt
authors.forename: J O L
authors.initials: JO
authors.lastname: Jørgensen
mesh_terms: D000236:Adenoma / Q000401:mortality*; D000310:Adrenal Gland Neoplasms / Q000401:mortality*; D003480:Cushing Syndrome / Q000401:mortality*; D006801:Humans; D009369:Neoplasms / Q000401:mortality