Older adults with Cushing’s disease present with fewer symptoms than younger patients
Key takeaways:
- Older age was tied to a higher prevalence of 10 comorbidities among a group of 608 people with Cushing’s disease.
- Younger age was associated with most hallmark features of Cushing’s disease.
The presentation of Cushing’s disease varies by age, with older adults having fewer hallmark features of the condition and more comorbidities, according to study findings published in The Journal of Clinical Endocrinology & Metabolism.
Researchers assessed data from 608 people diagnosed with Cushing’s disease and treated with a transsphenoidal tumor resection at 11 academic pituitary centers in the U.S. from 2003 to 2023 (82% women; 77.3% white). Patients were divided into 10-year age interval groups, with the youngest group consisting of those aged 10 to 19 years and the oldest containing adults aged 70 to 79 years. Researchers found Cushing’s disease presents differently as adults age, with older adults experiencing more comorbidities and complications, but fewer hallmark features such as weight gain, facial rounding and hirsutism.
“The diagnosis of Cushing’s disease remains challenging, particularly with age,” Won Kim, MD, associate clinical professor of neurosurgery and radiation oncology at the David Geffen School of Medicine at UCLA, told Healio. “The older a patient is, the more likely that he or she may have a slower-growing tumor with fewer classic manifestations of the disease.”
Kim and colleagues obtained data from the Registry of Adenomas of the Pituitary and Related Disorders. Hallmark features of Cushing’s disease were identified by consensus opinion.
The number of comorbidities increased with patient age (beta = 0.0466; P < .001), according to the researchers.
Older age was associated with several comorbidities for patients with Cushing’s disease, including hypertension (P < .001), diabetes (P < .001), hyperlipidemia (P < .001), cancer (P < .001), coronary artery disease (P < .001), chronic obstructive pulmonary disease (P = .044), cardiac arrhythmia (P = .023), hepatitis (P = .038), anxiety (P = .039) and osteopenia (P = .024). The most common comorbidity was hypertension, which was prevalent in 67.2% of participants.
In an analysis of presenting hallmark features of Cushing’s disease, younger age was positively associated with weight gain (P < .001), facial rounding (P < .001), abdominal striae (P < .001), hirsutism (P < .001), menstrual irregularities (P < .001) and acne (P < .001). Older age was positively tied to obstructive sleep apnea (P = .007). The most common hallmark feature of Cushing’s disease was weight gain, prevalent in 80.2% of patients.
“Our work highlights that we must lower our threshold for suspecting Cushing’s disease in patients without the classic physical manifestations as the age of the patient increases,” Kim said in an interview. “Subtle clues, such as increasingly difficult to control medical conditions such as hypertension and diabetes, may be the only things we see.”
Older age was associated with lower preoperative 24-hour urinary free cortisol levels (beta = –0.0256; P = 6.89 x 10-7), but higher postoperative nadir cortisol (beta = 0.0342; P = 1.03 x 10-4) and higher adrenocorticotropin (beta = 0.0204; P = 5.22 x 10-4).
In an assessment of tumor characteristics, older age was tied to having a higher Knosp grade tumor (beta = 0.011; P = .00435), greater tumor volume (beta = 0.0261; P = .0233) and higher maximum tumor dimension (beta = 0.009; P = 3.82 x 10-4). Older age was inversely associated with Ki-67 index, which is a measure of tumor’s proliferation (beta = –0.0459; P = 1.39 x 10-4).
Age was not associated with a patient’s number of surgical complications. Older age was linked to a greater prevalence of deep vein thrombosis or venous thromboembolism (beta = 0.07; P = .014). Younger age was tied to a higher prevalence of postoperative arginine vasopressin (beta = –0.02; P = .048).
Kim said the study’s findings should encourage health care professionals to adjust their methods for screening for Cushing’s disease in older adults.
“Improving our diagnostic sensitivity through our standardized assessments for the disease should account for these new findings,” Kim told Healio.
For more information:
Won Kim, MD, can be reached at wonkim@mednet.ucla.edu.
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