Gender differences in presentation and outcome of patients with Cushing's disease in Han Chinese

Abstract

The purpose of this study was to assess gender-related distinction in the performance of Cushing's disease (CD) regarding clinical features, radiological findings, neurological and endocrine status, surgical outcome, and quality of life in Han Chinese. A retrospective study was conducted on 87 patients treated by trans-sphenoidal surgery, between 2006 and 2011, at a single treatment center in Shandong Provincial Hospital, China. Features of CD were compared and quality of life was analyzed between genders. The female-to-male ratio was 2.78: 1. Results showed that men have a younger age of diagnosis (P<0.001), a larger adenoma diameter (P<0.001), and a higher invasion rate (P=0.032) and apoplexy rate (P=0.04) than women. To be specific, compared with women, men are more prone to suffering from osteoporosis, hypokalemia, sexual dysfunction, and hypertension (P < 0.05), have significantly higher preoperative and postoperative (six months after surgery) cortisol levels (P<0.001, P=0.003) and a higher recurrence rate (30.43% vs. 7.81%; P=0.028). No significant differences were seen in the CushingQoL scores between genders. Therefore, male patients with CD need more careful and long-term follow-up than female patients.

Association of hypokalemia with cortisol and ACTH levels in Cushing's disease

“…The incidence of hypokalemia in patients with CD in this study is 25.64% (50/195), higher than 10.42% (5/48) investigated in London, 10 but lower than 50.57% (44/87) investigated in Han Chinese. 12 Males were more prone to have hypokalemia (33.33% in male versus 20.51% in female). Some research also reported that there was a higher incidence of hypokalemia in male (41% (7/17) in male versus 12% (8/67) 17 in female; 69.57% (16/23) in male versus 43.75% (28/64) 12 in female).…”

“…12 Males were more prone to have hypokalemia (33.33% in male versus 20.51% in female). Some research also reported that there was a higher incidence of hypokalemia in male (41% (7/17) in male versus 12% (8/67) 17 in female; 69.57% (16/23) in male versus 43.75% (28/64) 12 in female). There was no clinical study systematically reporting the correlation of hypokalemia with cortisol and ACTH levels in patients with CD.…”

“…It occurred more frequently in cases with ectopic ACTH syndrome than those with CD. 4 The incidence of hypokalemia in patients with ectopic ACTH syndrome was 57-100% (57% (33/58), 5 64.0% (16/25), 6 71.3% (79/110), 7 85.7% (18/21), 8 95% (22/23), 9 and 100% doi: 10.1111/nyas.14205 (16/16) 10 ) according to the previous studies, while the incidence of hypokalemia was rarely reported in patients with CD as 10% (5/48), 10 9%(1/11), 11 and 50.57% (44/87), 12 respectively, which needs to be explored further. 3 Patients with ectopic ACTH syndrome, in whom hypokalemia occurs more frequently, usually have higher cortisol and ACTH levels compared with those with CD.…”

Epidemiology of hyperadrenocorticism among 210,824 dogs attending primary‐care veterinary practices in the UK from 2009 to 2014

“…In human medicine, hyperadrenocorticism has a substantial female over-representation, with female-to-male ratios commonly reported as 3:1 but the cause for this female predisposition in humans remains unclear (Boscaro et al 2001, Huan et al 2014, Newell-Price et al 2014. In contrast to male humans who have an increased risk of large corticotroph tumours, large pituitary tumours have been reported as more common in female dogs (Gallelli et al 2010, Huan et al 2014, Zilio et al 2014 ). This suggests differing aetiopathogenesis of PTHAC between humans The case counts from a 37·2% sample of dogs were used to estimate the total case count for each breed and dogs.…”

Sexual Dimorphism in Cellular and Molecular Features in Human ACTH-Secreting Pituitary Adenomas

“…ACTH-secreting pituitary adenomas, i.e., Cushing's disease, are known to occur far more frequently in women than in men [1,2] and, as we first showed some years ago [3], give rise to a somewhat different clinical course in the two sexes. In fact, men with Cushing's disease are more likely to be younger, exhibit a more severe clinical presentation and a less favourable response to surgical as well as medical treatment [3][4][5][6][7][8][9]. Furthermore, recently identified somatic mutations in the deubiquitinases USP8 and USP48 occurs with greater frequency in women than men with Cushing's…”