title: From first symptoms to final diagnosis of Cushing's disease: experiences of 176 patients.
abstract: To obtain structured information on the diagnostic delay in patients with Cushing's disease (CD) from the patients perspective to provide leverage points for earlier diagnosis.
  
  
  
  The study includes 176 patients with ACTH-dependent CD who had received pituitary surgery completed a self-developed questionnaire on their symptomatology before the illness was diagnosed, the course and length of the diagnostic process, and the role of the involved health care professionals.
  
  
  
  Data were analyzed statistically. Answers in free text options were categorized and counted.
  
  
  
  The overall diagnostic process took 3.8±4.8 years (median 2 years), during which 4.6±3.8 (1-30) physicians were consulted, most frequently the family physician (FP; 83.0%). The presented symptoms were various and often vague, e.g. 'poor general condition' (at FPs), or very common in the field of the visited specialist (i.e. 'skin changes' at dermatologists). Women recognized the first CD symptoms themselves significantly more frequently than men, whereas physicians recognized CD symptoms significantly more frequently in males.
  
  
  
  A clear difficulty of diagnosing CD seems that patients describe isolated symptoms to the FP or the respective specialists according to their fields of specialization. As FPs are contacted most frequently, they should be trained to recognize the broad spectrum of CD symptoms, especially in female patients with weight gain, and initiate endocrinological referral.
authors.affiliation: Department of NeurosurgeryUniversity Hospital Essen, University of Essen-Duisburg, Hufelandstrasse 55, 45147 Essen, GermanyDepartment of NeurosurgeryHospital of Cologne-Merheim, Cologne, GermanyDepartment of EndocrinologyUniversity of Essen-Duisburg, Essen, GermanyDepartment of NeurosurgeryUniversity of Erlangen-Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Tuebingen, Tuebingen, Germany ilonka.kreitschmann@uk-essen.de.
authors.forename: Ilonka
authors.initials: I
authors.lastname: Kreitschmann-Andermahr
authors.affiliation: Department of NeurosurgeryUniversity Hospital Essen, University of Essen-Duisburg, Hufelandstrasse 55, 45147 Essen, GermanyDepartment of NeurosurgeryHospital of Cologne-Merheim, Cologne, GermanyDepartment of EndocrinologyUniversity of Essen-Duisburg, Essen, GermanyDepartment of NeurosurgeryUniversity of Erlangen-Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Tuebingen, Tuebingen, Germany.
authors.forename: Tsambika
authors.initials: T
authors.lastname: Psaras
authors.affiliation: Department of NeurosurgeryUniversity Hospital Essen, University of Essen-Duisburg, Hufelandstrasse 55, 45147 Essen, GermanyDepartment of NeurosurgeryHospital of Cologne-Merheim, Cologne, GermanyDepartment of EndocrinologyUniversity of Essen-Duisburg, Essen, GermanyDepartment of NeurosurgeryUniversity of Erlangen-Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Tuebingen, Tuebingen, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Tsiogka
authors.affiliation: Department of NeurosurgeryUniversity Hospital Essen, University of Essen-Duisburg, Hufelandstrasse 55, 45147 Essen, GermanyDepartment of NeurosurgeryHospital of Cologne-Merheim, Cologne, GermanyDepartment of EndocrinologyUniversity of Essen-Duisburg, Essen, GermanyDepartment of NeurosurgeryUniversity of Erlangen-Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Tuebingen, Tuebingen, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Starz
authors.affiliation: Department of NeurosurgeryUniversity Hospital Essen, University of Essen-Duisburg, Hufelandstrasse 55, 45147 Essen, GermanyDepartment of NeurosurgeryHospital of Cologne-Merheim, Cologne, GermanyDepartment of EndocrinologyUniversity of Essen-Duisburg, Essen, GermanyDepartment of NeurosurgeryUniversity of Erlangen-Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Tuebingen, Tuebingen, Germany.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Kleist
authors.affiliation: Department of NeurosurgeryUniversity Hospital Essen, University of Essen-Duisburg, Hufelandstrasse 55, 45147 Essen, GermanyDepartment of NeurosurgeryHospital of Cologne-Merheim, Cologne, GermanyDepartment of EndocrinologyUniversity of Essen-Duisburg, Essen, GermanyDepartment of NeurosurgeryUniversity of Erlangen-Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Tuebingen, Tuebingen, Germany Department of NeurosurgeryUniversity Hospital Essen, University of Essen-Duisburg, Hufelandstrasse 55, 45147 Essen, GermanyDepartment of NeurosurgeryHospital of Cologne-Merheim, Cologne, GermanyDepartment of EndocrinologyUniversity of Essen-Duisburg, Essen, GermanyDepartment of NeurosurgeryUniversity of Erlangen-Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Tuebingen, Tuebingen, Germany.
authors.forename: Sonja
authors.initials: S
authors.lastname: Siegel
authors.affiliation: Department of NeurosurgeryUniversity Hospital Essen, University of Essen-Duisburg, Hufelandstrasse 55, 45147 Essen, GermanyDepartment of NeurosurgeryHospital of Cologne-Merheim, Cologne, GermanyDepartment of EndocrinologyUniversity of Essen-Duisburg, Essen, GermanyDepartment of NeurosurgeryUniversity of Erlangen-Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Tuebingen, Tuebingen, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Milian
authors.affiliation: Department of NeurosurgeryUniversity Hospital Essen, University of Essen-Duisburg, Hufelandstrasse 55, 45147 Essen, GermanyDepartment of NeurosurgeryHospital of Cologne-Merheim, Cologne, GermanyDepartment of EndocrinologyUniversity of Essen-Duisburg, Essen, GermanyDepartment of NeurosurgeryUniversity of Erlangen-Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Tuebingen, Tuebingen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Kohlmann
authors.affiliation: Department of NeurosurgeryUniversity Hospital Essen, University of Essen-Duisburg, Hufelandstrasse 55, 45147 Essen, GermanyDepartment of NeurosurgeryHospital of Cologne-Merheim, Cologne, GermanyDepartment of EndocrinologyUniversity of Essen-Duisburg, Essen, GermanyDepartment of NeurosurgeryUniversity of Erlangen-Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Tuebingen, Tuebingen, Germany.
authors.forename: Christa
authors.initials: C
authors.lastname: Menzel
authors.affiliation: Department of NeurosurgeryUniversity Hospital Essen, University of Essen-Duisburg, Hufelandstrasse 55, 45147 Essen, GermanyDepartment of NeurosurgeryHospital of Cologne-Merheim, Cologne, GermanyDepartment of EndocrinologyUniversity of Essen-Duisburg, Essen, GermanyDepartment of NeurosurgeryUniversity of Erlangen-Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Tuebingen, Tuebingen, Germany.
authors.forename: Dagmar
authors.identifier: 0000-0003-0357-4192
authors.initials: D
authors.lastname: Führer-Sakel
authors.affiliation: Department of NeurosurgeryUniversity Hospital Essen, University of Essen-Duisburg, Hufelandstrasse 55, 45147 Essen, GermanyDepartment of NeurosurgeryHospital of Cologne-Merheim, Cologne, GermanyDepartment of EndocrinologyUniversity of Essen-Duisburg, Essen, GermanyDepartment of NeurosurgeryUniversity of Erlangen-Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Tuebingen, Tuebingen, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Honegger
authors.affiliation: Department of NeurosurgeryUniversity Hospital Essen, University of Essen-Duisburg, Hufelandstrasse 55, 45147 Essen, GermanyDepartment of NeurosurgeryHospital of Cologne-Merheim, Cologne, GermanyDepartment of EndocrinologyUniversity of Essen-Duisburg, Essen, GermanyDepartment of NeurosurgeryUniversity of Erlangen-Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Tuebingen, Tuebingen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sure
authors.affiliation: Department of NeurosurgeryUniversity Hospital Essen, University of Essen-Duisburg, Hufelandstrasse 55, 45147 Essen, GermanyDepartment of NeurosurgeryHospital of Cologne-Merheim, Cologne, GermanyDepartment of EndocrinologyUniversity of Essen-Duisburg, Essen, GermanyDepartment of NeurosurgeryUniversity of Erlangen-Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Tuebingen, Tuebingen, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Müller
authors.affiliation: Department of NeurosurgeryUniversity Hospital Essen, University of Essen-Duisburg, Hufelandstrasse 55, 45147 Essen, GermanyDepartment of NeurosurgeryHospital of Cologne-Merheim, Cologne, GermanyDepartment of EndocrinologyUniversity of Essen-Duisburg, Essen, GermanyDepartment of NeurosurgeryUniversity of Erlangen-Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Tuebingen, Tuebingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Buchfelder
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000378:metabolism*; D000328:Adult; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000324:Adrenocorticotropic Hormone