Diabetes, Active Disease, and Afternoon Serum Cortisol Levels Predict Cushing’s Disease Mortality: A Cohort Study
Abstract Context Cushing’s disease (CD) is a life-threating disease, with increased mortality in comparison with the general population. Objective This study aimed to evaluate standardized mortality ratios (SMRs) in CD patients. We also analyzed independent risk factors related to increased mortalit...
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| Veröffentlicht in: | The journal of clinical endocrinology and metabolism 2021-01, Vol.106 (1), p.e103-e111 |
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| creator | Roldán-Sarmiento, Paola Lam-Chung, César Ernesto Hinojosa-Amaya, José Miguel Morales-García, Mariana Guillén-Placencia, María Fernanda Pérez-Flores, Greta E León-Suárez, Andrés León-Domínguez, Jefsi Balbuena-Álvarez, Salvador Nava de la Vega, Alfredo Pérez-Guzmán, Citlalli Mireya Gómez-Sámano, Miguel Ángel Enríquez-Estrada, Víctor Gómez-Pérez, Francisco J Cuevas-Ramos, Daniel |
| description | Abstract
Context
Cushing’s disease (CD) is a life-threating disease, with increased mortality in comparison with the general population.
Objective
This study aimed to evaluate standardized mortality ratios (SMRs) in CD patients. We also analyzed independent risk factors related to increased mortality.
Design
We conducted a longitudinal cohort study in a 3rd level specialty center, from 1979 to 2018, in patients with CD.
Results
From 1375 cases with a pathology diagnosis of pituitary adenoma, 191 cases had the confirmed diagnosis of CD (14%). A total of 172 patients completed follow-up, with a mean age at diagnosis of 33 ± 11 years, female predominance (n = 154, 89.5%), majority of them with microadenoma (n = 136, 79%), and a median follow-up of 7.5 years (2.4–15). Eighteen patients (10.5%) died, 8 of them (44%) were with active CD, 8 (44%) were under remission, and 2 (11%) were under disease control. Estimated all-cause SMR = 3.1, 95% confidence interval (CI) 1.9–4.8, P |
| doi_str_mv | 10.1210/clinem/dgaa774 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2455171793</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A702242487</galeid><oup_id>10.1210/clinem/dgaa774</oup_id><sourcerecordid>A702242487</sourcerecordid><originalsourceid>FETCH-LOGICAL-c464t-6227a876b83a84de120247404c2aed84893f3bf4b3786c260e573cac91012be63</originalsourceid><addsrcrecordid>eNqFkV9rFDEUxYModq2--igBXxQ6bf5NMuPbsG1VWFGogm8hk7mzTZmZbJNMYd_8Gn69fpKm7FZBCnIfLvfyO4cDB6HXlBxTRsmJHdwE40m3NkYp8QQtaC3KQtFaPUULQhgtasV-HqAXMV4RQoUo-XN0wDkllaqrBYqnzrSQIB7hxiZ3A_jURTARjrCZOtz0CcLk_YQvIMwjXvqQXPQDXsENDBF_C9A5m_ByjpduWt_--h0fDPCXzJrBpe0H3GThZT7xRZq77Uv0rDdDhFf7fYh-nJ99X34qVl8_fl42q8IKKVIhGVOmUrKtuKlEB5QRJpQgwjIDXSWqmve87UXLVSUtkwRKxa2xNSWUtSD5IXq3890Efz1DTHp00cIwmAn8HDUTZUkVVTXP6Nt_0Cs_hymn06wuJZVKSfqXWpsBtJt6n4Kx96a6UYQxwUSlMnX8CJWng9FZP0Hv8v8xgQ0-xgC93gQ3mrDVlOj7lvWuZb1vOQve7NPO7QjdH_yh1gy83wF-3vzP7A4rorFJ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2956167761</pqid></control><display><type>article</type><title>Diabetes, Active Disease, and Afternoon Serum Cortisol Levels Predict Cushing’s Disease Mortality: A Cohort Study</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Roldán-Sarmiento, Paola ; Lam-Chung, César Ernesto ; Hinojosa-Amaya, José Miguel ; Morales-García, Mariana ; Guillén-Placencia, María Fernanda ; Pérez-Flores, Greta E ; León-Suárez, Andrés ; León-Domínguez, Jefsi ; Balbuena-Álvarez, Salvador ; Nava de la Vega, Alfredo ; Pérez-Guzmán, Citlalli Mireya ; Gómez-Sámano, Miguel Ángel ; Enríquez-Estrada, Víctor ; Gómez-Pérez, Francisco J ; Cuevas-Ramos, Daniel</creator><creatorcontrib>Roldán-Sarmiento, Paola ; Lam-Chung, César Ernesto ; Hinojosa-Amaya, José Miguel ; Morales-García, Mariana ; Guillén-Placencia, María Fernanda ; Pérez-Flores, Greta E ; León-Suárez, Andrés ; León-Domínguez, Jefsi ; Balbuena-Álvarez, Salvador ; Nava de la Vega, Alfredo ; Pérez-Guzmán, Citlalli Mireya ; Gómez-Sámano, Miguel Ángel ; Enríquez-Estrada, Víctor ; Gómez-Pérez, Francisco J ; Cuevas-Ramos, Daniel</creatorcontrib><description>Abstract
Context
Cushing’s disease (CD) is a life-threating disease, with increased mortality in comparison with the general population.
Objective
This study aimed to evaluate standardized mortality ratios (SMRs) in CD patients. We also analyzed independent risk factors related to increased mortality.
Design
We conducted a longitudinal cohort study in a 3rd level specialty center, from 1979 to 2018, in patients with CD.
Results
From 1375 cases with a pathology diagnosis of pituitary adenoma, 191 cases had the confirmed diagnosis of CD (14%). A total of 172 patients completed follow-up, with a mean age at diagnosis of 33 ± 11 years, female predominance (n = 154, 89.5%), majority of them with microadenoma (n = 136, 79%), and a median follow-up of 7.5 years (2.4–15). Eighteen patients (10.5%) died, 8 of them (44%) were with active CD, 8 (44%) were under remission, and 2 (11%) were under disease control. Estimated all-cause SMR = 3.1, 95% confidence interval (CI) 1.9–4.8, P < 0.001. Cardiovascular disease was the main cause of death (SMR = 4.2, 1.5–9.3, P = 0.01). Multivariate Cox regression models adjusted for potential cofounders showed that diabetes (HR = 5.2, IC 95% 1.8–15.4, P = 0.002), high cortisol levels after 1600 hours at diagnosis (3.4, 2.3–7.0, P = 0.02), and active CD (7.5, 3.8–17.3, P = 0.003) significantly increased the risk of mortality.
Conclusions
Main cause of CD mortality was cardiovascular disease. Main risk factors for mortality were uncontrolled diabetes, persistently high cortisol levels after 1600 hours at diagnosis, and active disease at last follow-up.</description><identifier>ISSN: 0021-972X</identifier><identifier>EISSN: 1945-7197</identifier><identifier>DOI: 10.1210/clinem/dgaa774</identifier><identifier>PMID: 33108798</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>ACTH ; Adrenocorticotropic hormone ; Cardiovascular disease ; Cardiovascular diseases ; Cohort analysis ; Corticosteroids ; Cortisol ; Diabetes ; Diabetes mellitus ; Diagnosis ; Disease control ; Health aspects ; Hormones ; Medical research ; Medicine, Experimental ; Mexico ; Mortality ; Nervous system diseases ; Pituitary ; Population studies ; Regression analysis ; Remission ; Risk factors</subject><ispartof>The journal of clinical endocrinology and metabolism, 2021-01, Vol.106 (1), p.e103-e111</ispartof><rights>The Author(s) 2020. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2020</rights><rights>The Author(s) 2020. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><rights>COPYRIGHT 2021 Oxford University Press</rights><rights>The Author(s) 2020. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c464t-6227a876b83a84de120247404c2aed84893f3bf4b3786c260e573cac91012be63</citedby><cites>FETCH-LOGICAL-c464t-6227a876b83a84de120247404c2aed84893f3bf4b3786c260e573cac91012be63</cites><orcidid>0000-0001-9002-5276 ; 0000-0003-3605-6869 ; 0000-0002-7323-0582 ; 0000-0001-6330-670X ; 0000-0003-0204-7729 ; 0000-0003-0677-3509 ; 0000-0003-3406-7193 ; 0000-0003-2156-3753 ; 0000-0002-9800-3087 ; 0000-0003-0296-3030 ; 0000-0002-6113-5596 ; 0000-0002-6015-797X ; 0000-0001-5367-7777 ; 0000-0002-8596-6669</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33108798$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Roldán-Sarmiento, Paola</creatorcontrib><creatorcontrib>Lam-Chung, César Ernesto</creatorcontrib><creatorcontrib>Hinojosa-Amaya, José Miguel</creatorcontrib><creatorcontrib>Morales-García, Mariana</creatorcontrib><creatorcontrib>Guillén-Placencia, María Fernanda</creatorcontrib><creatorcontrib>Pérez-Flores, Greta E</creatorcontrib><creatorcontrib>León-Suárez, Andrés</creatorcontrib><creatorcontrib>León-Domínguez, Jefsi</creatorcontrib><creatorcontrib>Balbuena-Álvarez, Salvador</creatorcontrib><creatorcontrib>Nava de la Vega, Alfredo</creatorcontrib><creatorcontrib>Pérez-Guzmán, Citlalli Mireya</creatorcontrib><creatorcontrib>Gómez-Sámano, Miguel Ángel</creatorcontrib><creatorcontrib>Enríquez-Estrada, Víctor</creatorcontrib><creatorcontrib>Gómez-Pérez, Francisco J</creatorcontrib><creatorcontrib>Cuevas-Ramos, Daniel</creatorcontrib><title>Diabetes, Active Disease, and Afternoon Serum Cortisol Levels Predict Cushing’s Disease Mortality: A Cohort Study</title><title>The journal of clinical endocrinology and metabolism</title><addtitle>J Clin Endocrinol Metab</addtitle><description>Abstract
Context
Cushing’s disease (CD) is a life-threating disease, with increased mortality in comparison with the general population.
Objective
This study aimed to evaluate standardized mortality ratios (SMRs) in CD patients. We also analyzed independent risk factors related to increased mortality.
Design
We conducted a longitudinal cohort study in a 3rd level specialty center, from 1979 to 2018, in patients with CD.
Results
From 1375 cases with a pathology diagnosis of pituitary adenoma, 191 cases had the confirmed diagnosis of CD (14%). A total of 172 patients completed follow-up, with a mean age at diagnosis of 33 ± 11 years, female predominance (n = 154, 89.5%), majority of them with microadenoma (n = 136, 79%), and a median follow-up of 7.5 years (2.4–15). Eighteen patients (10.5%) died, 8 of them (44%) were with active CD, 8 (44%) were under remission, and 2 (11%) were under disease control. Estimated all-cause SMR = 3.1, 95% confidence interval (CI) 1.9–4.8, P < 0.001. Cardiovascular disease was the main cause of death (SMR = 4.2, 1.5–9.3, P = 0.01). Multivariate Cox regression models adjusted for potential cofounders showed that diabetes (HR = 5.2, IC 95% 1.8–15.4, P = 0.002), high cortisol levels after 1600 hours at diagnosis (3.4, 2.3–7.0, P = 0.02), and active CD (7.5, 3.8–17.3, P = 0.003) significantly increased the risk of mortality.
Conclusions
Main cause of CD mortality was cardiovascular disease. Main risk factors for mortality were uncontrolled diabetes, persistently high cortisol levels after 1600 hours at diagnosis, and active disease at last follow-up.</description><subject>ACTH</subject><subject>Adrenocorticotropic hormone</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Cohort analysis</subject><subject>Corticosteroids</subject><subject>Cortisol</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diagnosis</subject><subject>Disease control</subject><subject>Health aspects</subject><subject>Hormones</subject><subject>Medical research</subject><subject>Medicine, Experimental</subject><subject>Mexico</subject><subject>Mortality</subject><subject>Nervous system diseases</subject><subject>Pituitary</subject><subject>Population studies</subject><subject>Regression analysis</subject><subject>Remission</subject><subject>Risk factors</subject><issn>0021-972X</issn><issn>1945-7197</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNqFkV9rFDEUxYModq2--igBXxQ6bf5NMuPbsG1VWFGogm8hk7mzTZmZbJNMYd_8Gn69fpKm7FZBCnIfLvfyO4cDB6HXlBxTRsmJHdwE40m3NkYp8QQtaC3KQtFaPUULQhgtasV-HqAXMV4RQoUo-XN0wDkllaqrBYqnzrSQIB7hxiZ3A_jURTARjrCZOtz0CcLk_YQvIMwjXvqQXPQDXsENDBF_C9A5m_ByjpduWt_--h0fDPCXzJrBpe0H3GThZT7xRZq77Uv0rDdDhFf7fYh-nJ99X34qVl8_fl42q8IKKVIhGVOmUrKtuKlEB5QRJpQgwjIDXSWqmve87UXLVSUtkwRKxa2xNSWUtSD5IXq3890Efz1DTHp00cIwmAn8HDUTZUkVVTXP6Nt_0Cs_hymn06wuJZVKSfqXWpsBtJt6n4Kx96a6UYQxwUSlMnX8CJWng9FZP0Hv8v8xgQ0-xgC93gQ3mrDVlOj7lvWuZb1vOQve7NPO7QjdH_yh1gy83wF-3vzP7A4rorFJ</recordid><startdate>20210101</startdate><enddate>20210101</enddate><creator>Roldán-Sarmiento, Paola</creator><creator>Lam-Chung, César Ernesto</creator><creator>Hinojosa-Amaya, José Miguel</creator><creator>Morales-García, Mariana</creator><creator>Guillén-Placencia, María Fernanda</creator><creator>Pérez-Flores, Greta E</creator><creator>León-Suárez, Andrés</creator><creator>León-Domínguez, Jefsi</creator><creator>Balbuena-Álvarez, Salvador</creator><creator>Nava de la Vega, Alfredo</creator><creator>Pérez-Guzmán, Citlalli Mireya</creator><creator>Gómez-Sámano, Miguel Ángel</creator><creator>Enríquez-Estrada, Víctor</creator><creator>Gómez-Pérez, Francisco J</creator><creator>Cuevas-Ramos, Daniel</creator><general>Oxford University Press</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T5</scope><scope>7TM</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9002-5276</orcidid><orcidid>https://orcid.org/0000-0003-3605-6869</orcidid><orcidid>https://orcid.org/0000-0002-7323-0582</orcidid><orcidid>https://orcid.org/0000-0001-6330-670X</orcidid><orcidid>https://orcid.org/0000-0003-0204-7729</orcidid><orcidid>https://orcid.org/0000-0003-0677-3509</orcidid><orcidid>https://orcid.org/0000-0003-3406-7193</orcidid><orcidid>https://orcid.org/0000-0003-2156-3753</orcidid><orcidid>https://orcid.org/0000-0002-9800-3087</orcidid><orcidid>https://orcid.org/0000-0003-0296-3030</orcidid><orcidid>https://orcid.org/0000-0002-6113-5596</orcidid><orcidid>https://orcid.org/0000-0002-6015-797X</orcidid><orcidid>https://orcid.org/0000-0001-5367-7777</orcidid><orcidid>https://orcid.org/0000-0002-8596-6669</orcidid></search><sort><creationdate>20210101</creationdate><title>Diabetes, Active Disease, and Afternoon Serum Cortisol Levels Predict Cushing’s Disease Mortality: A Cohort Study</title><author>Roldán-Sarmiento, Paola ; Lam-Chung, César Ernesto ; Hinojosa-Amaya, José Miguel ; Morales-García, Mariana ; Guillén-Placencia, María Fernanda ; Pérez-Flores, Greta E ; León-Suárez, Andrés ; León-Domínguez, Jefsi ; Balbuena-Álvarez, Salvador ; Nava de la Vega, Alfredo ; Pérez-Guzmán, Citlalli Mireya ; Gómez-Sámano, Miguel Ángel ; Enríquez-Estrada, Víctor ; Gómez-Pérez, Francisco J ; Cuevas-Ramos, Daniel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c464t-6227a876b83a84de120247404c2aed84893f3bf4b3786c260e573cac91012be63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>ACTH</topic><topic>Adrenocorticotropic hormone</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Cohort analysis</topic><topic>Corticosteroids</topic><topic>Cortisol</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diagnosis</topic><topic>Disease control</topic><topic>Health aspects</topic><topic>Hormones</topic><topic>Medical research</topic><topic>Medicine, Experimental</topic><topic>Mexico</topic><topic>Mortality</topic><topic>Nervous system diseases</topic><topic>Pituitary</topic><topic>Population studies</topic><topic>Regression analysis</topic><topic>Remission</topic><topic>Risk factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Roldán-Sarmiento, Paola</creatorcontrib><creatorcontrib>Lam-Chung, César Ernesto</creatorcontrib><creatorcontrib>Hinojosa-Amaya, José Miguel</creatorcontrib><creatorcontrib>Morales-García, Mariana</creatorcontrib><creatorcontrib>Guillén-Placencia, María Fernanda</creatorcontrib><creatorcontrib>Pérez-Flores, Greta E</creatorcontrib><creatorcontrib>León-Suárez, Andrés</creatorcontrib><creatorcontrib>León-Domínguez, Jefsi</creatorcontrib><creatorcontrib>Balbuena-Álvarez, Salvador</creatorcontrib><creatorcontrib>Nava de la Vega, Alfredo</creatorcontrib><creatorcontrib>Pérez-Guzmán, Citlalli Mireya</creatorcontrib><creatorcontrib>Gómez-Sámano, Miguel Ángel</creatorcontrib><creatorcontrib>Enríquez-Estrada, Víctor</creatorcontrib><creatorcontrib>Gómez-Pérez, Francisco J</creatorcontrib><creatorcontrib>Cuevas-Ramos, Daniel</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>The journal of clinical endocrinology and metabolism</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Roldán-Sarmiento, Paola</au><au>Lam-Chung, César Ernesto</au><au>Hinojosa-Amaya, José Miguel</au><au>Morales-García, Mariana</au><au>Guillén-Placencia, María Fernanda</au><au>Pérez-Flores, Greta E</au><au>León-Suárez, Andrés</au><au>León-Domínguez, Jefsi</au><au>Balbuena-Álvarez, Salvador</au><au>Nava de la Vega, Alfredo</au><au>Pérez-Guzmán, Citlalli Mireya</au><au>Gómez-Sámano, Miguel Ángel</au><au>Enríquez-Estrada, Víctor</au><au>Gómez-Pérez, Francisco J</au><au>Cuevas-Ramos, Daniel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diabetes, Active Disease, and Afternoon Serum Cortisol Levels Predict Cushing’s Disease Mortality: A Cohort Study</atitle><jtitle>The journal of clinical endocrinology and metabolism</jtitle><addtitle>J Clin Endocrinol Metab</addtitle><date>2021-01-01</date><risdate>2021</risdate><volume>106</volume><issue>1</issue><spage>e103</spage><epage>e111</epage><pages>e103-e111</pages><issn>0021-972X</issn><eissn>1945-7197</eissn><abstract>Abstract
Context
Cushing’s disease (CD) is a life-threating disease, with increased mortality in comparison with the general population.
Objective
This study aimed to evaluate standardized mortality ratios (SMRs) in CD patients. We also analyzed independent risk factors related to increased mortality.
Design
We conducted a longitudinal cohort study in a 3rd level specialty center, from 1979 to 2018, in patients with CD.
Results
From 1375 cases with a pathology diagnosis of pituitary adenoma, 191 cases had the confirmed diagnosis of CD (14%). A total of 172 patients completed follow-up, with a mean age at diagnosis of 33 ± 11 years, female predominance (n = 154, 89.5%), majority of them with microadenoma (n = 136, 79%), and a median follow-up of 7.5 years (2.4–15). Eighteen patients (10.5%) died, 8 of them (44%) were with active CD, 8 (44%) were under remission, and 2 (11%) were under disease control. Estimated all-cause SMR = 3.1, 95% confidence interval (CI) 1.9–4.8, P < 0.001. Cardiovascular disease was the main cause of death (SMR = 4.2, 1.5–9.3, P = 0.01). Multivariate Cox regression models adjusted for potential cofounders showed that diabetes (HR = 5.2, IC 95% 1.8–15.4, P = 0.002), high cortisol levels after 1600 hours at diagnosis (3.4, 2.3–7.0, P = 0.02), and active CD (7.5, 3.8–17.3, P = 0.003) significantly increased the risk of mortality.
Conclusions
Main cause of CD mortality was cardiovascular disease. Main risk factors for mortality were uncontrolled diabetes, persistently high cortisol levels after 1600 hours at diagnosis, and active disease at last follow-up.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>33108798</pmid><doi>10.1210/clinem/dgaa774</doi><orcidid>https://orcid.org/0000-0001-9002-5276</orcidid><orcidid>https://orcid.org/0000-0003-3605-6869</orcidid><orcidid>https://orcid.org/0000-0002-7323-0582</orcidid><orcidid>https://orcid.org/0000-0001-6330-670X</orcidid><orcidid>https://orcid.org/0000-0003-0204-7729</orcidid><orcidid>https://orcid.org/0000-0003-0677-3509</orcidid><orcidid>https://orcid.org/0000-0003-3406-7193</orcidid><orcidid>https://orcid.org/0000-0003-2156-3753</orcidid><orcidid>https://orcid.org/0000-0002-9800-3087</orcidid><orcidid>https://orcid.org/0000-0003-0296-3030</orcidid><orcidid>https://orcid.org/0000-0002-6113-5596</orcidid><orcidid>https://orcid.org/0000-0002-6015-797X</orcidid><orcidid>https://orcid.org/0000-0001-5367-7777</orcidid><orcidid>https://orcid.org/0000-0002-8596-6669</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0021-972X |
| ispartof | The journal of clinical endocrinology and metabolism, 2021-01, Vol.106 (1), p.e103-e111 |
| issn | 0021-972X 1945-7197 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2455171793 |
| source | Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | ACTH Adrenocorticotropic hormone Cardiovascular disease Cardiovascular diseases Cohort analysis Corticosteroids Cortisol Diabetes Diabetes mellitus Diagnosis Disease control Health aspects Hormones Medical research Medicine, Experimental Mexico Mortality Nervous system diseases Pituitary Population studies Regression analysis Remission Risk factors |
| title | Diabetes, Active Disease, and Afternoon Serum Cortisol Levels Predict Cushing’s Disease Mortality: A Cohort Study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-20T20%3A44%3A43IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_proqu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Diabetes,%20Active%20Disease,%20and%20Afternoon%20Serum%20Cortisol%20Levels%20Predict%20Cushing%E2%80%99s%20Disease%20Mortality:%20A%20Cohort%20Study&rft.jtitle=The%20journal%20of%20clinical%20endocrinology%20and%20metabolism&rft.au=Rold%C3%A1n-Sarmiento,%20Paola&rft.date=2021-01-01&rft.volume=106&rft.issue=1&rft.spage=e103&rft.epage=e111&rft.pages=e103-e111&rft.issn=0021-972X&rft.eissn=1945-7197&rft_id=info:doi/10.1210/clinem/dgaa774&rft_dat=%3Cgale_proqu%3EA702242487%3C/gale_proqu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2956167761&rft_id=info:pmid/33108798&rft_galeid=A702242487&rft_oup_id=10.1210/clinem/dgaa774&rfr_iscdi=true |