Mortality in Cushings Disease

The causes of premature death in untreated Cushing’s syndrome are vascular disease (myocardial infarction/stroke), uncontrolled diabetes mellitus and complications and infections. Long-term mortality outcome studies on pituitary-dependent Cushing’s disease (CD) are limited to six studies in the English language literature. This paper reviews these studies on CD, other causes of Cushing’s syndrome being excluded, because CD represents 80% of patients with the syndrome. The period covered by these studies (1970–1990) is when transsphenoidal surgery was well established as primary treatment for CD. Two studies were exclusively from surgical centres and are likely biased in favour of surgically resectable adenomas, so this needs to be borne in mind when interpreting their results. The criteria for remission of hypercortisolism and persistent disease were variable. The overall number of patients in each report is small, and the number of deaths even smaller by epidemiological standards giving very wide confidence intervals to the standardised mortality ratios (SMR). Moreover, follow-up time was relatively short (median 10–12 years) for a disease diagnosed in the patients’ late 30s. Notwithstanding the above limitations of retrospective studies, and potential for posiPublished online: September 10, 2010 R.N. Clayton University Hospital of North Staffordshire, City General Hospital Stoke on Trent ST4 6QG (UK) Fax +44 1782 553 427, E-Mail r.n.clayton @ keele.ac.uk © 2010 S. Karger AG, Basel 0028–3835/10/0925–0071$26.00/0 Accessible online at: www.karger.com/nen D ow nl oa de d by : 54 .7 0. 40 .1 1 11 /1 9/ 20 17 1 0: 10 :5 6 A M