MISSION STUDY. A worldwide epidemiological study on the mortality associated with Cushing’s syndrome performed in nearly 5000 patients

Program: Late-Breaking Abstracts
Session: SAT-LB-Late-Breaking Poster Session 1
Bench to Bedside
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-LB-07
Rosario Pivonello*1, Pasquale Vitale2, Lorenzo Mantovani3, Roberta Ciampichini4, Galina A Melnichenko5, Sabina Zacharieva6, Feng Gu7, Oscar Domingo Bruno8, Nalini Shah9 and Annamaria Colao10
1Federico II University, 2University Federico II, Naples, Italy, 3University Federico II, 4CHARTA Foundation, Milan, Italy, 5Endocrinology Res Ctr, Moscow, Russia, 6Medical University, Sofia, Bulgaria, 7Peking Union Medical College Hospital, Beijing, China, 8Hospital de Clinicas, Buenos Aires, Argentina, 9KEM Hospital, Mumbai, India, 10Università Federico II di Napoli, Naples, Italy
Background: Cushing’s syndrome (CS) is associated with an increased mortality, which is up to 5 times higher than in normal population. MISSION study is a retrospective study focusing on the evaluation of the mortality in a very large population of patients with all types of CS.

Aim: The main objective of the study consists in the calculation of the risk factors and complications related mortality rate and survival curve of patients included in the study.

Patients and method: 4872 worldwide patients (1004 males and 3868 females entered the study. Pituitary-derived CS (68.5%) largely represented the most common form of the disease, followed by adrenal (14.9%) and ectopic (4.7%) CS. Occult and unknown origins amounted to 6,1% of cases. Moreover, 20.9% of patients showed active disease, whereas the remaining 79.1% had inactive disease, including patients evaluated after short-term remission (31.8%) or long-term cure (40.4%) and patients under pharmacological control (6.7%).

Results: The cumulative crude mortality rate was 6.86 per 1000 person-years; it was significantly higher in men than in women (11.4 vs 5.82, p<0.0001). Patients with active disease had a crude mortality rate significantly higher compared with patients in different disease status: crude mortality rate was 24.45 in patients with active disease and 4.83, 2.43 and 6.40 (p<0.001) in patients in remission, or cured patients or under pharmacologic control, respectively. Cured patients had lower crude mortality rate compared with patients in remission and those under pharmacologic control (p<0.001). Furthermore, a worse crude mortality rate was registered in patients with ectopic compared with those with pituitary (31.15 vs 4.25, p<0,001) and adrenal (3,21, p<0,001) disease while no statistically significant difference was found between patients with pituitary and adrenal disease. Finally, the analyzed risk factors or complications demonstrated to have an important impact on the mortality of patients with CS. In particular, mortality rate was higher in patients with hypertension (8.52 vs 2.73, p<0.0001), impairment of glucose metabolism (11.08 vs 4.39, p<0.0001); dyslipidemia (7,92 vs 5,99, p<0,01), coagulopathy (11.1 vs 6,3, p<0,01), cardiopathy (14.5 vs 5.3, p<0.0001) and infections (15.11 vs 4.74, p<0.0001) compared with patients without the specific complications.

Conclusion: The results of the current study performed in a very large number of patients derived by several country in the world demonstrated that the mortality associated with CS is strongly related to the disease activity and to their complications, mainly the impairment of glucose metabolism, cardiopathy and infections.

Disclosure: RP: Clinical Researcher, Novartis Pharmaceuticals, Clinical Researcher, Viropharma, Clinical Researcher, IBSA, Consultant, Novartis Pharmaceuticals, Consultant, Ipsen, Consultant, Pfizer, Inc., Consultant, Viropharma, Principal Investigator, Novartis Pharmaceuticals. Nothing to Disclose: PV, LM, RC, GAM, SZ, FG, ODB, NS, AC

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm