From first symptoms to final diagnosis of Cushing's disease: experiences of 176 patients

Abstract

Objective: To obtain structured information on the diagnostic delay in patients with Cushing's disease (CD) from the patients perspective to provide leverage points for earlier diagnosis. Design: The study includes 176 patients with ACTH-dependent CD who had received pituitary surgery completed a self-developed questionnaire on their symptomatology before the illness was diagnosed, the course and length of the diagnostic process, and the role of the involved health care professionals. Methods: Data were analyzed statistically. Answers in free text options were categorized and counted. Results: The overall diagnostic process took 3.8G4.8 years (median 2 years), during which 4.6G3.8 (1-30) physicians were consulted, most frequently the family physician (FP; 83.0%). The presented symptoms were various and often vague, e.g. 'poor general condition' (at FPs), or very common in the field of the visited specialist (i.e. 'skin changes' at dermatologists). Women recognized the first CD symptoms themselves significantly more frequently than men, whereas physicians recognized CD symptoms significantly more frequently in males. Conclusion: A clear difficulty of diagnosing CD seems that patients describe isolated symptoms to the FP or the respective specialists according to their fields of specialization. As FPs are contacted most frequently, they should be trained to recognize the broad spectrum of CD symptoms, especially in female patients with weight gain, and initiate endocrinological referral.

The Differential Diagnosis of Discrepant Thyroid Function Tests: Insistent Pitfalls and Updated Flow-Chart Based on a Long-Standing Experience

“…The 14 patients included in this series experienced a diagnostic delay of >2 years following the estimated onset of clinical manifestations of thyrotoxicosis. Interestingly, this interval is similar to that reported in Cushing' disease (31). Finally, our case series shows that self-reported symptoms and signs in patients can be misleading, since some individuals with assay interference exhibited features of apparent thyrotoxicosis.…”

Cardiovascular events in patients with mild autonomous cortisol secretion: analysis with artificial neural networks

“…We recorded the CVEs occurrence (myocardial infarction, stroke, transient ischemic attack, angina pectoris, pulmonary embolism, intracerebral hemorrhage, peripheral artery disease) during the 10 years before the AI finding and during a variable follow-up period (mean: 161.8 ± 45.1, range: 120-426 months) after the AI finding. The observation period has been extended till 10 years before the AI finding since the diagnosis of overt hypercortisolism is done with 3-8 years of delay (30), which should be probably longer in scarcely symptomatic patients. The study complies with the Declaration of Helsinki and it has been approved by the Ethical Committee of Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy.…”

Validation of the Tuebingen CD-25 Inventory as a Measure of Postoperative Health-Related Quality of Life in Patients Treated for Cushing's Disease

“…The clinical characteristics, diagnostic processes, and demographic data (education and work status) have been reported elsewhere [12] and are summarized here (table 1). …”