Broersen Leonie H A, van Haalen Femke M, Kienitz Tina, Biermasz Nienke R, Strasburger Cristian J, Dekkers Olaf M, Pereira Alberto M
Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, Netherlands.
Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, Netherlands.
Front Endocrinol (Lausanne). 2019 Aug 30;10:580. doi: 10.3389/fendo.2019.00580. eCollection 2019.
Sex differences in clinical picture of ACTH-dependent Cushing's syndrome are controversial, except for the known higher prevalence in females. We compared a broad range of potential differences to enable a more accurate understanding of the clinical picture of sex-specific ACTH-dependent Cushing's syndrome. Cohort study including consecutive patients with ACTH-dependent Cushing's syndrome from Leiden and Berlin diagnosed between 2000 and 2016. We compared clinical presentation, biochemical parameters, diagnostic tests, surgical outcome, and comorbidities between men and women. We included 130 patients: 37 males and 93 females. With similar cortisol concentrations, ACTH concentrations were higher in males than females at time of diagnosis (median: 116 vs. 57 ng/L). The prevalence of osteoporosis was higher in males than in females (48.6 vs. 25.0%), persisting after surgery, with more vertebral fractures (16.2 vs. 5.4%) before surgery. Males showed more anemia (75.9 vs. 36.8%) after surgery. There were no differences in etiology, pituitary tumor size, diagnostic and therapeutic strategy, or surgical outcome between sexes. Based on this study, males and females with ACTH-dependent Cushing's syndrome present different clinical patterns. However, these differences do not justify different diagnostic strategies or treatment based on sex, considering the similar surgical outcome. Clinicians should be alert to diagnose accompanying osteoporosis (with fractures) in male patients with ACTH-dependent Cushing's syndrome.
除了已知女性患病率较高外，促肾上腺皮质激素（ACTH）依赖性库欣综合征临床表现中的性别差异存在争议。我们比较了一系列潜在差异，以便更准确地了解性别特异性ACTH依赖性库欣综合征的临床表现。队列研究纳入了2000年至2016年间在莱顿和柏林诊断为ACTH依赖性库欣综合征的连续患者。我们比较了男性和女性之间的临床表现、生化参数、诊断测试、手术结果和合并症。我们纳入了130名患者：37名男性和93名女性。在皮质醇浓度相似的情况下，男性在诊断时的ACTH浓度高于女性（中位数：116对57 ng/L）。男性骨质疏松症的患病率高于女性（48.6%对25.0%），术后仍持续存在，术前椎体骨折更多（16.2%对5.4%）。男性术后贫血更为常见（75.9%对36.8%）。两性在病因、垂体肿瘤大小、诊断和治疗策略或手术结果方面没有差异。基于这项研究，ACTH依赖性库欣综合征的男性和女性表现出不同的临床模式。然而，考虑到相似的手术结果，这些差异并不能证明基于性别的不同诊断策略或治疗是合理的。临床医生应警惕诊断ACTH依赖性库欣综合征男性患者伴发的骨质疏松症（伴骨折）。
