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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Endocrinol. | doi: 10.3389/fendo.2019.00580

Sex differences in presentation but not in outcome for ACTH-dependent Cushing’s syndrome.

  • 1Leiden University Medical Center, Netherlands
  • 2Charité Medical University of Berlin, Germany

Background: Sex differences in clinical picture of ACTH-dependent Cushing’s syndrome are controversial, except for the known higher prevalence in females. We compared a broad range of potential differences to enable a more accurate understanding of the clinical picture of sex-specific ACTH-dependent Cushing’s syndrome.
Methods: Cohort study including consecutive patients with ACTH-dependent Cushing’s syndrome from Leiden and Berlin diagnosed between 2000-2016. We compared clinical presentation, biochemical parameters, diagnostic tests, surgical outcome, and comorbidities between men and women.
Results: We included 130 patients: 37 males and 93 females. With similar cortisol concentrations, ACTH concentrations were higher in males than females at time of diagnosis (median: 116 ng/L versus 57 ng/L). The prevalence of osteoporosis was higher in males than in females (48.6% versus 25.0%), persisting after surgery, with more vertebral fractures (16.2% versus 5.4%) before surgery. Males showed more anemia (75.9% versus 36.8%) after surgery. There were no differences in etiology, pituitary tumor size, diagnostic and therapeutic strategy, or surgical outcome between sexes.
Conclusions: Based on this study, males and females with ACTH-dependent Cushing’s syndrome present different clinical patterns. However, these differences do not justify different diagnostic strategies or treatment based on sex, considering the similar surgical outcome. Clinicians should be alert to diagnose accompanying osteoporosis (with fractures) in male patients with ACTH-dependent Cushing’s syndrome.

Keywords: Cushing's disease, Ectopic Cushing’s syndrome, Sex diff erences, Clinical picture, clinical outcome

Received: 08 Apr 2019; Accepted: 08 Aug 2019.

Edited by:

Günter K. Stalla, Max Planck Institute of Psychiatry (MPI), Germany

Reviewed by:

Edward R. Laws, Brigham and Women's Hospital, Harvard Medical School, United States
Ning-Ai Liu, Cedars-Sinai Medical Center, United States  

Copyright: © 2019 Broersen, Van Haalen, Kienitz, Biermasz, Strasburger, Dekkers and Pereira. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: MD. Leonie H. Broersen, Leiden University Medical Center, Leiden, Netherlands,