Document Detail


Gender-related differences in the presentation and course of Cushing's disease.
MedLine Citation:
PMID:  12679438     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Cushing's disease (CD) presents a marked female preponderance, but whether this skewed gender distribution has any relevance to the presentation and outcome of CD is not known. The aim of the present study was the comparison of clinical features, biochemical indices of hypercortisolism, and surgical outcome among male and female patients with CD. The study population comprised 280 patients with CD (233 females, 47 males) collected by the Italian multicentre study. Epidemiological data, frequency of clinical signs and symptoms, urinary free cortisol (UFC), plasma ACTH and cortisol levels, responses to dynamic testing, and surgical outcome were compared in female and male patients. Male patients with CD presented at a younger age, compared with females (30.5 +/- 1.93 vs. 37.1 +/- 0.86 yr, P < 0.01), with higher UFC and ACTH levels (434.1 +/- 51.96 vs. 342.1 +/- 21.01% upper limit of the normal range for UFC, P < 0.05; 163.9 +/- 22.92 vs. 117.7 +/- 9.59% upper limit of the normal range for ACTH, P < 0.05). No difference in ACTH and cortisol responses to CRH, gradient at inferior petrosal sinus sampling, and cortisol inhibition after low-dose dexamethasone was recorded between sexes. In contrast, the sensitivity of the high-dose dexamethasone test was significantly lower in male than in female patients. Of particular interest, symptoms indicative of hypercatabolic state were more frequent in male patients; indeed, males presented a higher prevalence of osteoporosis, muscle wasting, striae, and nephrolitiasis. Conversely, no symptom was more frequent in female patients with CD. Patients with myopathy, hypokalemia, and purple striae presented significantly higher UFC levels, compared with patients without these symptoms. Lastly, in male patients, pituitary imaging was more frequently negative and immediate and late surgical outcome less favorable. In conclusion, CD appeared at a younger age and with a more severe clinical presentation in males, compared with females, together with more pronounced elevation of cortisol and ACTH levels. Furthermore, high-dose dexamethasone suppression test and pituitary imaging were less reliable in detecting the adenoma in male patients, further burdening the differential diagnosis with ectopic ACTH secretion. Lastly, the postsurgical course of the disease carried a worse prognosis in males. Altogether, these findings depict a different pattern for CD in males and females.
Authors:
Francesca Pecori Giraldi; Mirella Moro; Francesco Cavagnini;
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  88     ISSN:  0021-972X     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-04-07     Completed Date:  2003-05-09     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1554-8     Citation Subset:  AIM; IM    
Affiliation:
University of Milan, Ospedale San Luca, Istituto Auxologico Italiano, Italy.
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MeSH Terms
Descriptor/Qualifier:
Adenoma / diagnosis,  surgery
Adrenocorticotropic Hormone / blood
Adult
Age Factors
Aging
Corticotropin-Releasing Hormone / diagnostic use
Cushing Syndrome / diagnosis*,  epidemiology,  physiopathology*
Dexamethasone / administration & dosage,  diagnostic use
Female
Glucocorticoids / administration & dosage,  diagnostic use
Humans
Hydrocortisone / blood,  urine
Italy / epidemiology
Male
Pituitary Neoplasms / diagnosis,  surgery
Prognosis
Sex Characteristics*
Chemical
Reg. No./Substance:
0/Glucocorticoids; 50-02-2/Dexamethasone; 50-23-7/Hydrocortisone; 9002-60-2/Adrenocorticotropic Hormone; 9015-71-8/Corticotropin-Releasing Hormone

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