ECE2022 Poster Presentations Adrenal and Cardiovascular Endocrinology (87 abstracts)
The endocrine society practice guideline revisited: why do nowadays patients undergo screening for cushing’ syndrome, and with which outcome?
Leah Braun 1 , Frederick Vogel 1 , Stephanie Zopp 1 , Thomas Marchant Seiter 1 , German Rubinstein 1 , Christina M. Berr 2 , Heike Künzel 1 , Felix Beuschlein 3 & Martin Reincke 1
1Endokrinologie, Nephrologie und weitere Sektionen - Medizinische Klinik und Poliklinik IV - Campus Innenstadt, München, Germany; 2University Hospital Augsburg, Augsburg, Germany; 3Klinik für Endokrinologie, Diabetologie und Klinische Ernährung USZ Campus, Zürich, Switzerland
Background: Cushing’s syndrome (CS) is a rare but very severe condition with high morbidity and mortality. Patients are often diagnosed late in the course of the disease, many years after onset of symptoms. New approaches like extended screening of at risk populations, alternative biomarkers and clinical scores have been developed to improve diagnostic accuracy. However, there is still a debate, whether certain patient populations should be screened for CS outside the framework of current guideline recommendations.
Material and method: As part of the prospective German Cushing’s registry, we studied 433 patients. They had suspected Cushing’s syndrome or autonomous cortisol secretion. All patients underwent a standardized clinical examination including 20 clinical key items of CS. The main reason why they were referred to our department was documented. Finally, Cushing’s syndrome was confirmed in 98 patients, autonomous cortisol secretion was diagnosed in 44 patients and CS was excluded in 291 subjects using the three standard screening tests urinary free cortisol, late-night salivary cortisol, the 1 mg-dexamethasone suppression-test and long-term clinical observation.
Results: Patients were referred for 18 different key presenting reasons. Five of them were more common in patients with Cushing’s syndrome than in subjects in whom CS was excluded: osteoporosis (7% vs. 2%, P=0.02), adrenal adenoma (17% vs. 8%, P=0.01), metabolic syndrome (10% vs. 4%, P=0.02), myopathy (9% vs. 2%, P=0.01) and presence of multiple symptoms (16% vs. 1%, P < 0.001). Obesity was the single factor that was much more common in patients with exclusion of Cushing’s syndrome (29% vs. 4%, P <0.001). Obesity was also the most frequent reason to initiate a screening.
Conclusions: Obesity should not be a standard reason to screen a patient for CS. The results of our study confirm the current screening recommendations.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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