Age-Related Differences in Manifestation of Cushing Disease Identified

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Although Cushing disease most often occurs in young women, individual cases have been reported in older patients.
Although Cushing disease most often occurs in young women, individual cases have been reported in older patients.

Older patients with Cushing disease have a catabolic phenotype, with a lower body mass index and increased muscle wasting, which differs from the presentation in younger patients, according to a recent study published in Clinical Endocrinology.

This retrospective study reviewed case records of patients who had undergone pituitary surgery (either selective resection or hemi-hypophysectomy). The study population was divided into 3 arms: patients <60 years of age (n=90), patients >60 years of age (n=45), and patients >60 years of age with a nonfunctional pituitary adenoma (n=45). Baseline characteristics, hormonal assessments, medical comorbidities, and surgery outcomes were evaluated.

In older patients, weight gain was less common, central obesity was more common, muscle wasting was more common, and body mass index was significantly lower compared with younger patients. Older patients also were more likely to have hypertension, diabetes, cardiovascular disease, and venous thromboembolism. Patients with a nonfunctioning pituitary adenoma experienced a greater loss of vision. Surgical remission rates were comparable between all age groups (>60=84.4%, <60=86.7%).

In conclusion, older patients with Cushing disease were found to have a different clinical phenotype and an increased risk for comorbidities; however, surgery is a viable option with remission rates comparable to those seen in younger patients.

Reference

Qiao N, Swearingen B, Tritos NA. Cushing's disease in older patients: Presentation and outcome [published online June 25, 2018]. Clin Endocrinol (Oxf). doi: 10.1111/cen.13799

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