Cushing's syndrome in women: age-related differences in etiology and clinical picture

Objective To evaluate the clinical presentation, biochemical profile, and etiology of Cushing's syndrome (CS) in women stratified by age. Methods Retrospective study of patients with CS, treated at Rabin Medical Center from 2000 to 2020, or Maccabi Health-care Services in Israel from 2005 to 2017. Disease etiology, presentation and biochemical profile were compared according to age at diagnosis: <= 45, 46-64, or > 65 years. Study was approved by the Ethics Review Boards of both facilities with waiver of consent. Results The cohort included 142 women (mean age, 46.0 +/- 15.1 years):81 (57.0%) with Cushing's disease (CD), and 61 (43.0%) with adrenal CS. Pituitary etiology was more common among women < 45 (70.6%), compared with patients > 65 years (31.6%) (P < 0.05). Among CS patients, hypercortisolism was diagnosed in the context of screening after an adrenal incidentaloma detection in 15.0% of patients < 45 and 53.8% of > 65 years (P < 0.001). Weight gain was evident in 57.4% of women < 45 (56.3% CD, 60.0% CS), and 15.8% of women > 65 years (50% CD, 0% CS) (P = 0.011). Mean UFC levels were highest for women < 45 (3.8 x ULN) and lowest for > 65 years (2.3 x ULN) (P < 0.001). Conclusion We have shown for the first time that women with CS > 65 years of age more commonly have adrenal etiology. The initial presentation of CS also differs between age groups, where women < 45 years are likely to present with weight gain, while those > 65 years are frequently diagnosed incidentally, when screening for hypercortisolism in the presence of an adrenal incidentaloma.

Automated summary

This study aimed to evaluate the clinical presentation, biochemical profile, and etiology of Cushing's syndrome (CS) in women stratified by age. The results showed that adrenal etiology was more common in women over 65 years old, while pituitary etiology was more common in women under 45 years old. The initial presentation of CS also differed between age groups.