Diagnostic dilemma in Cushing's syndrome: discrepancy between patient-reported and physician-assessed manifestations

被引:0
|
作者
Motomura, Yuma [1 ]
Urai, Shin [1 ]
Bando, Hironori [2 ]
Yamamoto, Masaaki [1 ]
Suzuki, Masaki [1 ]
Yamamoto, Naoki [1 ]
Iguchi, Genzo [1 ,3 ,4 ]
Ogawa, Wataru [1 ]
Fukuoka, Hidenori [2 ]
机构
[1] Kobe Univ, Grad Sch Med, Dept Internal Med, Div Diabet & Endocrinol, Kobe, Hyogo 6500017, Japan
[2] Kobe Univ Hosp, Dept Internal Med, Div Diabet & Endocrinol, Kobe, Hyogo 6500017, Japan
[3] Kobe Univ, Med Ctr Student Hlth, Kobe, Hyogo 6578501, Japan
[4] Kobe Univ, Dept Biosignal Pathophysiol, Grad Sch Med, Kobe, Hyogo 6578501, Japan
基金
日本学术振兴会;
关键词
Cushing's syndrome; Cortisol; Patients' recognition; Early diagnosis; HYPERTENSION; DISEASE; PREVALENCE; ENDOCRINE;
D O I
10.1007/s12020-024-03935-9
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
PurposeEarly diagnosis and immediate treatment of Cushing's syndrome (CS) are critical for a better prognosis but remain a challenge. However, few comprehensive reports have focused on this issue or investigated whether patient-reported manifestations are consistent with physician-assessed symptoms of CS. This study aimed to clarify the differences in patient-reported and physician-assessed manifestations of signs and symptoms of CS that prevent early diagnosis.MethodsThis single-center retrospective study included 52 patients with CS (16 with Cushing's disease and 36 with adrenal CS). Upon clinical diagnosis, medical records were used to independently review the patient-reported and physician-assessed manifestations of typical (such as purple striae and proximal myopathy) and nonspecific features (such as hirsutism and hypertension). The correlations and differences between the patient-reported and physician-assessed manifestations were then analyzed.ResultsWe observed a positive correlation between the total number of manifestations of nonspecific features reported by patients and those assessed by physicians, but not for typical features. Moreover, manifestations reported by the patients were less frequent than those assessed by physicians for typical features, leading to discrepancies between the two groups. In contrast, there were no differences in most nonspecific features between the patient-reported and physician-assessed manifestations. Notably, the concordance between patient-reported and physician-assessed manifestations of typical features was not associated with urinary free cortisol levels.ConclusionRegardless of disease severity, patients often do not complain of the typical features of CS that are crucial for formulating a diagnosis.
引用
收藏
页码:417 / 427
页数:11
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