Etiology and clinical profile of patients with Cushing's syndrome: A single center experience.
BACKGROUND
There is little published literature on the profile of patients with Cushing's syndrome (CS) from India. The aim of this study was to compile data of CS patients treated at this hospital.


METHODS
Patients referred to the endocrine services of this hospital for diagnosis/treatment of CS from January 1985 to July 2012 were the subjects for this study. All patients had detailed medical history, physical examination and biochemical and hormonal assays (which changed with availability of tests and changing views). Assays for plasma adrenocorticotropic hormone (ACTH) (late 90s), salivary cortisol estimation, IJV sampling for ACTH and corticotrophin releasing hormone stimulation tests were added on later. Imaging included computed tomography (CT), magnetic resonance imaging (since the late 80's) and (68)Ga DOTA-TOC/FDG PET-CT (2008).


RESULTS
Three hundred sixty-four patients (250 females, 114 males, age 6 months to 65 years, mean 28 years + 12 years) were diagnosed to have CS during this period. Two hundred and ninety-three patients (80.5%) were ACTH dependent (CD 215, ectopic ACTH syndrome 22, occult ACTH source 56) while 71 (19.5%) were ACTH independent (adrenal carcinoma 36, adenoma 30, primary pigmented nodular adrenal disease 4, AIMAH 1). Pituitary macro adenoma was seen in 14% of the CD cases. The most common presenting complaints were hypertension and diabetes mellitus. A total of 63% patients complained of weight gain while 15% had lost weight. Myopathy, infections, skeletal fractures and psychiatric problems were the other common observations in our patients.


CONCLUSIONS
The clinical spectrum was broad. CD was the most common cause for CS.
Department of Endocrinology and Metabolism, AIIMS, New Delhi, India.
Ariacherry C
AC
Ammini
Department of Endocrinology and Metabolism, AIIMS, New Delhi, India.
Nikhil
N
Tandon
Department of Endocrinology and Metabolism, AIIMS, New Delhi, India.
Nandita
N
Gupta
Department of Radiology, AIIMS, New Delhi, India.
Ashu Seith
AS
Bhalla
Department of Radiology, AIIMS, New Delhi, India.
Kandaswamy
K
Devasenaspathy
Department of Biostatistics, AIIMS, New Delhi, India.
Guresh
G
Kumar
Department of Endocrinology and Metabolism, AIIMS, New Delhi, India.
Jaiprakash P
JP
Sahoo
Department of Endocrinology and Metabolism, AIIMS, New Delhi, India.
Sachin
S
Chittawar
Department of Endocrinology and Metabolism, AIIMS, New Delhi, India.
Jim
J
Philip
Department of Endocrinology and Metabolism, AIIMS, New Delhi, India.
Manas P
MP
Baruah
Department of Endocrinology and Metabolism, AIIMS, New Delhi, India.
C S
CS
Dwarakanath
Department of Endocrinology and Metabolism, AIIMS, New Delhi, India.
Sudhir
S
Tripathi
Adrenal adenoma; adrenal carcinoma; adrenal cushing's; adrenocorticotropic hormone; cushing's disease; cushing's syndrome; ectopic adrenocorticotropic hormone syndrome