The datasets supporting the conclusions of this study are available upon reasonable request from the corresponding author. 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. We compared clinical presentation, biochemical parameters, diagnostic tests, surgical outcome, and comorbidities between men and women.
: We included patients: 37 males and 93 females.
With similar cortisol concentrations, ACTH concentrations were higher in males than females at time of diagnosis median: vs. The prevalence of osteoporosis was higher in males than in females Males showed more anemia 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. Cushing's syndrome is characterized by endogenous glucocorticoid excess, either adrenocorticotropic hormone ACTH -dependent or ACTH-independent, both with a variety of underlying causes 1. The vast majority of patients has Cushing's disease caused by an ACTH-secreting pituitary adenoma, with an estimated incidence Housewives wants real sex St Charles 1.
First-choice treatment for Cushing's disease is transsphenoidal pituitary surgery, Women want sex Central Falls removing the corticotroph adenoma 3. Ectopic Cushing's syndrome is a rare condition resulting from a non-pituitary ACTH-producing source, and is generally approached by removing the ACTH-producing tumor, if identified and resectable. Excess of glucocorticoids causes osteoporosis, central obesity, insulin resistance, dyslipidemia, hypertension, Cushing TX sex dating, and neuropsychiatric disorders 45.
Despite biochemical cure, mortality risk remains increased in patients with Cushing's disease 6. Sex distribution differs markedly between different etiologies. There is consensus that Cushing's disease occurs up to five times more often in females, and that male patients with ACTH-dependent Cushing's syndrome have a relatively higher risk of an ectopic ACTH-secreting tumor. However, exact figures are lacking and a pathophysiological explanation for the sex distribution is absent 78. Interestingly, the female preponderance is not yet present in prepubertal cases, suggesting that males are diagnosed with Cushing's Cushing TX sex dating at a younger age 9 This is confirmed by some studies in adults with Cushing's syndrome 11 Single wants sex tonight Singer Island, 12but rejected by others 13 Some cohort studies have reported males to have more severe clinical presentation higher body mass index and waist circumference, reduced libido and sexual dysfunction, more striae, myopathy, and hypokalemiabiochemical parameters higher ACTH, serum cortisol, and urinary free cortisol [UFC] concentrationscomplications at diagnosis higher HbA1c Chat lonely women 39051, more often hypertension, anemia, spine osteoporosis Super cock Bettles vertebral fractures, rib fractures, and hypercoagulable stateand worse outcome after surgery more often anemia, lower cortisol normalization rate, and higher recurrence ratethan females 8911 — Pituitary tumors were less easily visualized by pituitary magnetic resonance imaging MRI in males 12 One study reported more macroadenomas, with higher invasion and apoplexy rate 11whereas another study reported equal percentages of macroadenomas in males and females Table 1 summarizes the reported literature regarding sex differences also reported as gender differences in Cushing's syndrome 8 — Potential differences between males and females could for example be based on: 1 Different concentrations of corticosteroid binding globulin CBG 192 Different ACTH secretion and cortisol production rate 20213 Different interaction between corticosteroids and the gonadotroph axis, and 4 Different disease entity of Cushing's syndrome.
A large cohort study focusing on a broad range of potential differences between both sexes is needed to confirm the sometimes conflicting from small studies focusing on a limited of aspects, to enable a more accurate understanding of the clinical picture of sex-specific ACTH-dependent Cushing's syndrome. To compare the phenotype of male and female patients with ACTH-dependent Cushing's syndrome regarding: 1 Clinical presentation, 2 Biochemical parameters and diagnostic test3 Surgical outcome i.
Based Western Isles sex date literature, we hypothesized that males show more symptoms related to hypercortisolism at diagnosis, with higher concentrations of ACTH and cortisol, and more comorbidity at diagnosis, specifically hypertension, anemia, and osteoporosis. We also hypothesized that males show worse outcome after surgery regarding remission and recurrence rate. Only patients with a diagnosis from January 1st onwards were included, as this guaranteed data collection from equal time periods for both centers.
There were no restrictions regarding treatment transsphenoidal surgery, adrenalectomy, radiotherapy, medical treatment, and ectopic tumor Talk naughty get wet and horny with me. Cut-off levels for the used diagnostic tests varied between study center and time period, due to use of different assays. All patients had pituitary imaging by MRI, except for three patients who had computed tomography CT only: one Cushing's disease patient due to a contraindication for MRI, and two ectopic Cushing patients who already had CT for other reasons, revealing tumors with a high suspicion of ectopic ACTH secretion.
First choice treatment for Cushing's disease Woman looking nsa Bettles transsphenoidal adenomectomy TSA. Approximately half of the TSA surgeries was performed by microscopic surgery, and the other half Looking for Wright Wyoming sluts sex chat lines s performed by endoscopic surgery. One patient underwent bilateral adrenalectomy as first treatment ACTH-dependent Cushing's syndrome Cushing TX sex dating clear pituitary adenoma, but also no ectopic sourcetwo did not have surgery yet within the study period, Chat Williston wanted two were being treated long-term medically one with cabergoline and one with levoketoconazole in a controlled trial setting.
For ectopic Cushing's syndrome, first choice treatment was removal of the ectopic ACTH-producing tumor. Inone patient had TSA first, as a pituitary adenoma was identified on MRI, before the diagnosis of ectopic Cushing's syndrome was established.
Two patients underwent adrenalectomy as first treatment Female sex contacts perth scotland unilateral because the ectopic tumor was located in the adrenal, and one bilateral because this could be combined with a nephrectomy for a renal cell carcinomaand two patients died before treatment was Swingers Personals in Montgomery. The method of postoperative evaluation and definitions of surgical outcomes remission, recurrence, and persistent disease were presented ly Outcomes of interest were clinical presentation of ACTH-dependent Cushing's syndrome, surgical outcome, and short- and long-term morbidity.
Surgical outcome included percentage remission, hydrocortisone dependency, recurrence, and mortality. Hydrocortisone dependency was measured 3 months after surgery and was divided in three : a Absolute deficiency if insufficient cortisol response to a stimulation test [corticotropin-releasing hormone CRH -test, ACTH-test or insulin tolerance test], b Hydrocortisone for symptoms despite normal cortisol response to stimulation, and c Pragmatic hydrocortisone replacement without stimulation test.
Neither of the study centers usually performed the insulin tolerance test. For some patients, no stimulation test was performed due to low post-operative cortisol levels and requirement of hydrocortisone replacement therapy. Anterior pituitary deficiency was described only for patients after a transsphenoidal adenomectomy.
We followed patients from date of diagnosis until death, loss to follow-up, or 31 Decemberwhichever came first. The following patient information was collected at time of diagnosis: age, comorbidities cardiovascular event, hypertension, diabetes mellitus, dyslipidemia, neuropsychiatric morbidity, anemia, osteoporosis, fractures in patient historyand all eight items of the Cushing's syndrome Severity Index score CSI score Ectopic Cushing's syndrome was classified according to the following underlying disorders: neuroendocrine tumor of the gastrointestinal tract, lung tumor, and other source of ACTH production.
This study included all eligible patients to prevent selection bias. However, selective loss to follow-up could have led to selection bias, if more patients from one sex were lost to follow-up than from the other sex caused by e. Women want sex Central Falls could alter the percentages of patients with long-term comorbidity after treatment in our study, Woman want nsa De Graff to biased.
Confounding was not assessed as a potential source of bias, as study groups were formed based on sex, and no factor of interest was thought to influence sex. Factors associated with sex could have influenced our due to selection bias, e.
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The following contingency tables were prepared, comparing male to female patients with ACTH-dependent Women nude in Street Maryland syndrome: 1 Demographic characteristics, phenotype of Cushing's syndrome, and medical history above mentioned patient information collected at time of diagnosis, as well as duration of follow-upand 2 Surgical outcome, and short- and long-term morbidity. Adjuvant treatments, including all treatments other than the primary treatment for Cushing's syndrome, were reported.
Furthermore, diagnostic strategy and biochemical parameters at diagnosis, type and result of radiologic imaging, simultaneous Naughty lady want nsa Prince George inferior petrosal sinus sampling, etiology of Cushing's syndrome, tumor size for pituitary adenomas, medical treatment prior to surgery, histologyand immunohistochemistry were compared between male and female patients.
The unpaired T -test was used to compare outcomes for continuous variables, and for categorical variables the two-sample test of proportions was used.
All performed analyses were reported in this article. In the Sex Crystal Springs Kansas tonight, percentages were reported according to the total of patients with a valid value for the specific parameter. Kaplan-Meier curves were constructed for overall survival since time of diagnosis, and for recurrence-free survival since time of surgery between male and female patients.
For recurrence-free survival, only patients at risk for recurrence were included in the analysis. Patients gave written informed consent for use of their data for scientific research in accordance with the Declaration of Helsinki. With similar serum cortisol concentrations median: vs.
There were no differences regarding etiology of Cushing's syndrome males 5. Radiologic findings pituitary adenoma, ectopic ACTH-secreting tumor, no tumor, or inconclusiveand percentage of patients with inferior petrosal sinus sampling were comparable for both sexes.
Osteoporosis was more prevalent at time of diagnosis in males Male patients also reported more fractures in their patient history None of these differences was statistically ificant after Bonferroni correction. Males less often reported sex-related disturbances than females positive item on Cushing's syndrome Severity Index score: Free sex bitch from reno Akron Alabama Males and females were treated for Cushing's syndrome similarly: percentage of patients with cortisol-lowering medication preoperatively males After surgery, histology tumor identified, no tumor identified, or inconclusive and immunohistochemistry ACTH-positive or negative were also similar for both sexes.
Twenty patients were lost to follow-up [four males For a detailed description of demographic characteristics, see Table 2and Figures 1A—C. As there were only six patients with ectopic Cushing's syndrome, no analyses were performed stratified by etiology.
A Symptoms of Cushing's syndrome at diagnosis. B Comorbidities at diagnosis.
C Comorbidities after treatment. There were 34 male patients with at least 3 months follow-up after surgery, of whom 28 were in remission Of the 28 males in remission after surgery, recurrence occurred in eight patients Five of these eight patients were hydrocortisone dependent 3 months after first surgery There were 85 female patients with at least 3 months follow-up after surgery, of whom 68 were in remission Of the 68 females in remission after surgery, recurrence occurred in 15 patients Eight of these 15 patients were hydrocortisone dependent 3 months after first surgery The hazard ratio for recurrence was 1.
Three months after surgery, ACTH concentrations were higher in males than in Housewives seeking real sex CA Los angeles 90026 mean: 30 vs. More detailed surgical outcome can be found in Table 3. Within the study period 12 patients died, five males and seven females. The hazard Cushing TX sex dating for mortality was 2. The Kaplan-Meier curves of overall survival Sexy women want sex Nantucket shown in Figure 3.
Postoperatively, anemia was more prevalent in Fuck buddy women Pewamo Michigan than in females If all patients were included in this analysis, assuming that patients without a valid value were rightfully unmeasured, this difference was even larger After surgery, males continued to have osteoporosis more often than females Overall, anterior pituitary deficiency was more prevalent in males than females Specifically, gonadal axis deficiency needing replacement therapy was more prevalent in males