University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, 5001 Aarau, Switzerland.
Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland.
Eur J Endocrinol. 2024 Jul 2;191(1):97-105. doi: 10.1093/ejendo/lvae069.
There is increasing evidence that multisystem morbidity in patients with Cushing's disease (CD) is only partially reversible following treatment. We investigated complications from multiple organs in hospitalized patients with CD compared to patients with nonfunctioning pituitary adenoma (NFPA) after pituitary surgery.
Population-based retrospective cohort study using data from the Swiss Federal Statistical Office between January 2012 and December 2021.
Through 1:5 propensity score matching, we compared hospitalized patients undergoing pituitary surgery for CD or NFPA, addressing demographic differences. The primary composite endpoint included all-cause mortality, major adverse cardiac events (ie, myocardial infarction, unstable angina, heart failure, cardiac arrest, and ischemic stroke), hospitalization for psychiatric disorders, sepsis, severe thromboembolic events, and fractures in need of hospitalization. Secondary endpoints comprised individual components of the primary endpoint and surgical reintervention due to disease persistence or recurrence.
After matching, 116 patients with CD (mean age 45.4 years [SD, 14.4], 75.0% female) and 396 with NFPA (47.3 years [14.3], 69.7% female) were included and followed for a median time of 50.0 months (IQR 23.5, 82.0) after pituitary surgery. Cushing's disease presence was associated with a higher incidence rate of the primary endpoint (40.6 vs 15.7 events per 1000 person-years, hazard ratio [HR] 2.75; 95% CI, 1.54-4.90). Cushing's disease patients also showed increased hospitalization rates for psychiatric disorders (HR 3.27; 95% CI, 1.59-6.71) and a trend for sepsis (HR 3.15; 95% CI, .95-10.40).
Even after pituitary surgery, CD patients faced a higher hazard of complications, especially psychiatric hospitalizations and sepsis.
越来越多的证据表明，库欣病（CD）患者的多系统发病率在治疗后仅部分可逆。我们调查了与接受垂体手术的无功能垂体腺瘤（NFPA）患者相比，CD 住院患者的多个器官并发症。
使用瑞士联邦统计局 2012 年 1 月至 2021 年 12 月的数据，进行基于人群的回顾性队列研究。
通过 1:5 倾向评分匹配，我们比较了接受垂体手术治疗 CD 或 NFPA 的住院患者，以解决人口统计学差异。主要复合终点包括全因死亡率、主要不良心脏事件（即心肌梗死、不稳定型心绞痛、心力衰竭、心脏骤停和缺血性中风）、因精神障碍住院、脓毒症、严重血栓栓塞事件和需要住院治疗的骨折。次要终点包括主要终点的各个组成部分以及由于疾病持续或复发而进行的手术再次干预。
匹配后，纳入了 116 例 CD 患者（平均年龄 45.4 岁[标准差 14.4]，75.0%为女性）和 396 例 NFPA 患者（47.3 岁[14.3]，69.7%为女性），并在垂体手术后中位时间为 50.0 个月（IQR 23.5，82.0）进行随访。库欣病的存在与主要终点的发生率较高相关（40.6 与 15.7 例/1000 人年，风险比[HR]2.75；95%CI，1.54-4.90）。库欣病患者的精神障碍住院率也有所增加（HR 3.27；95%CI，1.59-6.71），脓毒症呈上升趋势（HR 3.15；95%CI，.95-10.40）。
即使在接受垂体手术后，CD 患者面临更高的并发症风险，尤其是精神科住院和脓毒症。
