Journal article
Cushing Disease Clinical Phenotype and Tumor Behavior Vary With Age: Diagnostic and Perioperative Implications
The journal of clinical endocrinology and metabolism, v 110(9), pp 2595-2604
01 Sep 2025
PMID: 39745928
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Little is known about presenting clinical characteristics, tumor biology, and surgical morbidity of Cushing disease (CD) with aging.
Using a large multi-institutional data set, we assessed diagnostic and prognostic significance of age in CD through differences in presentation, laboratory results, tumor characteristics, and postoperative outcomes.
Data from the Registry of Adenomas of the Pituitary and Related Disorders (RAPID) were reviewed for patients with CD treated with transsphenoidal tumor resection at 11 centers between 2003 and 2023. Outcomes assessed included comorbidities, presenting features, preoperative endocrine evaluations, perioperative characteristics, postoperative endocrine laboratory values, and complications.
Of the 608 patients evaluated, 496 (81.6%) were female; median age at surgery was 44 years (range, 10-78 years). Increasing age was associated with increasing comorbidities, frailty, rates of postoperative thromboembolic disease, Knosp grade, tumor size, and postoperative cortisol and adrenocorticotropin nadirs. Conversely, increasing age was associated with decreased hallmark CD features, preoperative 24-hour urinary free cortisol, Ki-67 indices, and arginine vasopressin deficiency. Younger patients presented more frequently with weight gain, facial rounding/plethora, abdominal striae, hirsutism, menstrual irregularities, dorsocervical fat pad, and acne. Obstructive sleep apnea and infections were more common with increasing age.
There are age-dependent differences in clinical presentation, tumor behavior, and postoperative outcomes in patients with CD. Compared to younger patients, older patients present with a less classic phenotype characterized by fewer hallmark features, more medical comorbidities, and larger tumors. Notably, age-related differences suggest a more indolent tumor behavior in older patients, potentially contributing to delayed diagnosis and increased perioperative risk. These findings underscore the need for tailored diagnostic and therapeutic approaches across age groups, with a focus on managing long-term comorbidities and optimizing surgical outcomes.
Metrics
1 Record Views
Details
- Title
- Cushing Disease Clinical Phenotype and Tumor Behavior Vary With Age: Diagnostic and Perioperative Implications
- Creators
- Jorge Eduardo Salcedo-Sifuentes - University of California, Los AngelesRyan Shih - University of California, Los AngelesAnthony P Heaney - University of California, Los AngelesMarvin Bergsneider - University of California, Los AngelesMarilene B Wang - University of California, Los AngelesInes Donangelo - University of California, Los AngelesJivianne Lee - University of California, Los AngelesWilliam Delery - University of California, Los AngelesMichael Karsy - Drexel UniversityVarun R Kshettry - Cleveland ClinicKevin C J Yuen - Barrow Neurological InstituteJames J Evans - Thomas Jefferson UniversityGarni Barkhoudarian - Pacific Heart InstituteDonato R Pacione - New York UniversityPaul A Gardner - University of Pittsburgh Medical CenterJuan C Fernandez-Miranda - Palo Alto UniversityCarolina Benjamin - University of Miami Health SystemGabriel Zada - University of Southern CaliforniaRobert C Rennert - University of UtahJulie M Silverstein - Washington University in St. LouisMichael R Chicoine - University of MissouriJiyoon Kim - University of California, Los AngelesGang Li - University of California, Los AngelesAndrew S Little - Barrow Neurological InstituteWon Kim - University of California, Los Angeles
- Publication Details
- The journal of clinical endocrinology and metabolism, v 110(9), pp 2595-2604
- Publisher
- Oxford University Press
- Grant note
- Barrow Foundation This work was supported by the Lodestar Foundation
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Neurosurgery
- Web of Science ID
- WOS:001397135100001
- Scopus ID
- 2-s2.0-105013389880
- Other Identifier
- 991022197329004721
UN Sustainable Development Goals (SDGs)
This publication has contributed to the advancement of the following goals:
Source: SDGs in the Output
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Endocrinology & Metabolism