Endocrine Abstracts

Introduction: Cushing’s syndrome (CS) results from prolonged glucocorticoid excess. Both iatrogenic and endogenous CS cause somatic and neuropsychiatric morbidity that do not fully reverse after biochemical disease control. However, the real-world socio-economic consequences for patients and their families are largely unknown.

Aim: To determine the impact of CS on work status, income, education, marital status, parenthood, and depression before and after treatment.

Design: A nationwide registry-based cohort study.

Methods: Using the Danish health registries, we identified 411 patients diagnosed and operated for benign pituitary or adrenal CS between 1986–2017. Pituitary/adrenal ratio was 1.16. We matched each patient with ten persons from the background population of same sex and age (the reference population). We obtained registry data on socio-economic factors and anti-depressive medication, and followed them from up to ten years before diagnosis to ten years after surgery. We calculated crude and adjusted relative-risk (RR) of patients in working age returning to fulltime work two years after surgery using a modified Poisson regression.

Results: During a median follow-up of 13.4 years (5516 person-years), 20% (n = 84) of CS patients and 11% (n = 454) of reference population had died (P < 0.001). Compared to the reference population, we found that fewer patients were in a fulltime job from seven years before diagnosis [68.2% vs 74.6%, P = 0.03] to ten years after surgery [50.0% vs 70.3%, P < 0.001] with the biggest difference observed the year after surgery [33.1% vs 72.2%, P < 0.001]. Mean annual income was decreased by 6300 EUR (CI 95 % 3400–9200) in the years after surgery. More patients were prescribed antidepressant drugs from six years before diagnosis [10% vs 5%, P = 0.004] and up to ten years after surgery [16% vs 9%, P = 0.003]. We found no differences between CS and reference population in educational achievement, marital status, and parenthood. Among CS patients, female sex, high age, low education, comorbidity, and a history of depression predicted lower likelihood of returning to work. When adjusted for the other factors, adrenal CS patients had better chance of returning to work than pituitary CS.

Conclusion: 1) CS negatively affects essential socioeconomic variables even many years before the diagnosis, 2) Risk predictors included female sex, high age, history of depression, and pituitary CS, 3) The data underpin the importance of an early diagnosis and may also have implications for the management of patients receiving pharmacological glucocorticoid treatment.