title: Predictors of mortality and long-term outcomes in treated Cushing's disease: a study of 346 patients.
abstract: BACKGROUND
  Active Cushing's disease (CD) confers a 4-fold increase in mortality and is associated with significant morbidities. Although excess mortality risk may persist even after CD treatment, predictors of risk in treated CD are not well understood.
  
  
  OBJECTIVE
  To identify predictors of mortality, cardiovascular (CV) disease, and recurrence after long-term follow-up among patients with treated CD.
  
  
  METHODS
  A retrospective chart review was conducted to evaluate patients with CD who underwent transsphenoidal adenectomy with a single surgeon.
  
  
  METHODS
  Patients were categorized based on disease response after initial treatment. Cox proportional hazard models identified predictors of mortality, recurrence, and CV outcomes in the overall cohort and each subgroup.
  
  
  RESULTS
  Three hundred forty-six subjects were included. Mean age was 39.9 years, and mean duration of follow-up was 6.3 years (range, 1 mo to 30 y). Duration of exposure to excess glucocorticoids, estimated by duration of symptoms before diagnosis until remission was achieved by any means, was 40.0 months. Multivariate analyses demonstrated that duration of glucocorticoid exposure elevated the risk of death (P = .038), as did older age at diagnosis (P = 0.0001) and preoperative ACTH concentration (P = .007). Among patients who achieved remission, depression increased the hazard of death (P < .01). Male sex, age at diagnosis, diabetes, and depression elevated the risk of CV disease (P < .05).
  
  
  CONCLUSIONS
  Long-term follow-up of a large cohort of treated patients with CD identified several novel predictors of mortality. These data illustrate the importance of early recognition and treatment of CD. Long-term follow-up, with management of persistent comorbidities, is needed even after successful treatment of CD.
authors: Division of Endocrinology, Mount Sinai Medical Center, New York, New York 10029, USA.
authors: Jessica K
authors: JK
authors: Lambert
authors: Levana
authors: L
authors: Goldberg
authors: Sofia
authors: S
authors: Fayngold
authors: Jane
authors: J
authors: Kostadinov
authors: Kalmon D
authors: KD
authors: Post
authors: Eliza B
authors: EB
authors: Geer
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000401:mortality* / Q000601:surgery*; D000236:Adenoma / Q000401:mortality* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D047748:Pituitary ACTH Hypersecretion / Q000401:mortality* / Q000601:surgery*; D011237:Predictive Value of Tests; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
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