Screening of hypercortisolism among patients with hypertension: an Italian nationwide survey
Purpose Screening of Cushing Syndrome (CS) and Mild Autonomous Cortisol Secretion (MACS) in hypertensive patients is crucial for proper treatment. The aim of the study was to investigate screening and management of hypercortisolism among patients with hypertension in Italy. Methods A 10 item-questio...
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| Veröffentlicht in: | Journal of endocrinological investigation 2024, Vol.47 (12), p.3029-3038 |
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| creator | Di Dalmazi, G. Goi, J. Burrello, J. Tucci, L. Cicero, A. F. G. Mancusi, C. Coletti Moia, E. Iaccarino, G. Borghi, C. Muiesan, M. L. Ferri, C. Mulatero, P. |
| description | Purpose
Screening of Cushing Syndrome (CS) and Mild Autonomous Cortisol Secretion (MACS) in hypertensive patients is crucial for proper treatment. The aim of the study was to investigate screening and management of hypercortisolism among patients with hypertension in Italy.
Methods
A 10 item-questionnaire was delivered to referral centres of European and Italian Society of Hypertension (ESH and SIIA) in a nationwide survey. Data were analyzed according to type of centre (excellence
vs
non-excellence), geographical area, and medical specialty.
Results
Within 14 Italian regions, 82 centres (30% excellence, 78.790 patients during the last year, average 600 patients/year) participated to the survey. Internal medicine (44%) and cardiology (31%) were the most prevalent medical specialty. CS and MACS were diagnosed in 313 and 490 patients during the previous 5 years. The highest number of diagnoses was reported by internal medicine and excellence centres. Screening for hypercortisolism was reported by 77% in the presence of specific features of CS, 61% in resistant hypertension, and 38% in patients with adrenal mass. Among screening tests, the 24 h urinary free cortisol was the most used (66%), followed by morning cortisol and ACTH (54%), 1 mg-dexamethasone suppression test (49%), adrenal CT or MRI scans (12%), and late night salivary cortisol (11%). Awareness of referral centres with expertise in management of CS was reported by 67% of the participants, which reduced to 44% among non-excellence centres.
Conclusions
Current screening of hypercortisolism among hypertensive patients is unsatisfactory. Strategies tailored to different medical specialties and type of centres should be conceived. |
| doi_str_mv | 10.1007/s40618-024-02387-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11549160</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3126410761</sourcerecordid><originalsourceid>FETCH-LOGICAL-c426t-4c12395167c5a031327cd602f14c75d341176b2b63b1b0a8086944ad0e8a8093</originalsourceid><addsrcrecordid>eNp9kUtv1TAQhS0Eog_4A11UkdiwSZmxHdvpBqGKPqRKLOgSyXIc33tdJfatnbS6_x7TlFJYsLDG1nxzfEaHkCOEEwSQnzIHgaoGysthStb0FdlHSaFWTInXL-575CDnWwAmC_aW7DHVIqMN7pMf321yLviwruKq2uy2LtmYJp_j4PNYmTGWztZM3oUpVw9-2izQ5EL2MZxWJlRXkxl8qaFgMTz43lV5Tvdu9468WZkhu_dP9ZDcnH-9Obusr79dXJ19ua4tp2KquUXK2gaFtI0BVpxJ2wugK-RWNj3jiFJ0tBOsww6MAiVazk0PTpVHyw7J50V2O3ej622xmsygt8mPJu10NF7_3Ql-o9fxXiM2vEUBReHjk0KKd7PLkx59tm4YTHBxzpqBxAabVqqCfvgHvY1zCmU9zZAKjiAFFooulE0x5-RWz24Q9K_w9BKeLuHpx_A0LUPHL_d4HvmdVgHYAuTSCmuX_vz9H9mfqkOlvg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3126410761</pqid></control><display><type>article</type><title>Screening of hypercortisolism among patients with hypertension: an Italian nationwide survey</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Di Dalmazi, G. ; Goi, J. ; Burrello, J. ; Tucci, L. ; Cicero, A. F. G. ; Mancusi, C. ; Coletti Moia, E. ; Iaccarino, G. ; Borghi, C. ; Muiesan, M. L. ; Ferri, C. ; Mulatero, P.</creator><creatorcontrib>Di Dalmazi, G. ; Goi, J. ; Burrello, J. ; Tucci, L. ; Cicero, A. F. G. ; Mancusi, C. ; Coletti Moia, E. ; Iaccarino, G. ; Borghi, C. ; Muiesan, M. L. ; Ferri, C. ; Mulatero, P.</creatorcontrib><description>Purpose
Screening of Cushing Syndrome (CS) and Mild Autonomous Cortisol Secretion (MACS) in hypertensive patients is crucial for proper treatment. The aim of the study was to investigate screening and management of hypercortisolism among patients with hypertension in Italy.
Methods
A 10 item-questionnaire was delivered to referral centres of European and Italian Society of Hypertension (ESH and SIIA) in a nationwide survey. Data were analyzed according to type of centre (excellence
vs
non-excellence), geographical area, and medical specialty.
Results
Within 14 Italian regions, 82 centres (30% excellence, 78.790 patients during the last year, average 600 patients/year) participated to the survey. Internal medicine (44%) and cardiology (31%) were the most prevalent medical specialty. CS and MACS were diagnosed in 313 and 490 patients during the previous 5 years. The highest number of diagnoses was reported by internal medicine and excellence centres. Screening for hypercortisolism was reported by 77% in the presence of specific features of CS, 61% in resistant hypertension, and 38% in patients with adrenal mass. Among screening tests, the 24 h urinary free cortisol was the most used (66%), followed by morning cortisol and ACTH (54%), 1 mg-dexamethasone suppression test (49%), adrenal CT or MRI scans (12%), and late night salivary cortisol (11%). Awareness of referral centres with expertise in management of CS was reported by 67% of the participants, which reduced to 44% among non-excellence centres.
Conclusions
Current screening of hypercortisolism among hypertensive patients is unsatisfactory. Strategies tailored to different medical specialties and type of centres should be conceived.</description><identifier>ISSN: 1720-8386</identifier><identifier>ISSN: 0391-4097</identifier><identifier>EISSN: 1720-8386</identifier><identifier>DOI: 10.1007/s40618-024-02387-2</identifier><identifier>PMID: 38913251</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adrenocorticotropic hormone ; Adult ; Cortisol ; Cushing syndrome ; Cushing Syndrome - diagnosis ; Cushing Syndrome - epidemiology ; Cushing Syndrome - metabolism ; Dexamethasone ; Endocrinology ; Female ; Hormones ; Humans ; Hydrocortisone ; Hydrocortisone - analysis ; Hydrocortisone - metabolism ; Hypertension ; Hypertension - diagnosis ; Hypertension - epidemiology ; Internal Medicine ; Italy - epidemiology ; Male ; Mass Screening - methods ; Mass Screening - statistics & numerical data ; Medicine ; Medicine & Public Health ; Metabolic Diseases ; Middle Aged ; Original ; Original Article ; Patients ; Surveys ; Surveys and Questionnaires</subject><ispartof>Journal of endocrinological investigation, 2024, Vol.47 (12), p.3029-3038</ispartof><rights>The Author(s) 2024</rights><rights>2024. The Author(s).</rights><rights>The Author(s) 2024. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2024 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c426t-4c12395167c5a031327cd602f14c75d341176b2b63b1b0a8086944ad0e8a8093</cites><orcidid>0000-0002-1291-8906</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s40618-024-02387-2$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s40618-024-02387-2$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38913251$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Di Dalmazi, G.</creatorcontrib><creatorcontrib>Goi, J.</creatorcontrib><creatorcontrib>Burrello, J.</creatorcontrib><creatorcontrib>Tucci, L.</creatorcontrib><creatorcontrib>Cicero, A. F. G.</creatorcontrib><creatorcontrib>Mancusi, C.</creatorcontrib><creatorcontrib>Coletti Moia, E.</creatorcontrib><creatorcontrib>Iaccarino, G.</creatorcontrib><creatorcontrib>Borghi, C.</creatorcontrib><creatorcontrib>Muiesan, M. L.</creatorcontrib><creatorcontrib>Ferri, C.</creatorcontrib><creatorcontrib>Mulatero, P.</creatorcontrib><title>Screening of hypercortisolism among patients with hypertension: an Italian nationwide survey</title><title>Journal of endocrinological investigation</title><addtitle>J Endocrinol Invest</addtitle><addtitle>J Endocrinol Invest</addtitle><description>Purpose
Screening of Cushing Syndrome (CS) and Mild Autonomous Cortisol Secretion (MACS) in hypertensive patients is crucial for proper treatment. The aim of the study was to investigate screening and management of hypercortisolism among patients with hypertension in Italy.
Methods
A 10 item-questionnaire was delivered to referral centres of European and Italian Society of Hypertension (ESH and SIIA) in a nationwide survey. Data were analyzed according to type of centre (excellence
vs
non-excellence), geographical area, and medical specialty.
Results
Within 14 Italian regions, 82 centres (30% excellence, 78.790 patients during the last year, average 600 patients/year) participated to the survey. Internal medicine (44%) and cardiology (31%) were the most prevalent medical specialty. CS and MACS were diagnosed in 313 and 490 patients during the previous 5 years. The highest number of diagnoses was reported by internal medicine and excellence centres. Screening for hypercortisolism was reported by 77% in the presence of specific features of CS, 61% in resistant hypertension, and 38% in patients with adrenal mass. Among screening tests, the 24 h urinary free cortisol was the most used (66%), followed by morning cortisol and ACTH (54%), 1 mg-dexamethasone suppression test (49%), adrenal CT or MRI scans (12%), and late night salivary cortisol (11%). Awareness of referral centres with expertise in management of CS was reported by 67% of the participants, which reduced to 44% among non-excellence centres.
Conclusions
Current screening of hypercortisolism among hypertensive patients is unsatisfactory. Strategies tailored to different medical specialties and type of centres should be conceived.</description><subject>Adrenocorticotropic hormone</subject><subject>Adult</subject><subject>Cortisol</subject><subject>Cushing syndrome</subject><subject>Cushing Syndrome - diagnosis</subject><subject>Cushing Syndrome - epidemiology</subject><subject>Cushing Syndrome - metabolism</subject><subject>Dexamethasone</subject><subject>Endocrinology</subject><subject>Female</subject><subject>Hormones</subject><subject>Humans</subject><subject>Hydrocortisone</subject><subject>Hydrocortisone - analysis</subject><subject>Hydrocortisone - metabolism</subject><subject>Hypertension</subject><subject>Hypertension - diagnosis</subject><subject>Hypertension - epidemiology</subject><subject>Internal Medicine</subject><subject>Italy - epidemiology</subject><subject>Male</subject><subject>Mass Screening - methods</subject><subject>Mass Screening - statistics & numerical data</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metabolic Diseases</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Original Article</subject><subject>Patients</subject><subject>Surveys</subject><subject>Surveys and Questionnaires</subject><issn>1720-8386</issn><issn>0391-4097</issn><issn>1720-8386</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><recordid>eNp9kUtv1TAQhS0Eog_4A11UkdiwSZmxHdvpBqGKPqRKLOgSyXIc33tdJfatnbS6_x7TlFJYsLDG1nxzfEaHkCOEEwSQnzIHgaoGysthStb0FdlHSaFWTInXL-575CDnWwAmC_aW7DHVIqMN7pMf321yLviwruKq2uy2LtmYJp_j4PNYmTGWztZM3oUpVw9-2izQ5EL2MZxWJlRXkxl8qaFgMTz43lV5Tvdu9468WZkhu_dP9ZDcnH-9Obusr79dXJ19ua4tp2KquUXK2gaFtI0BVpxJ2wugK-RWNj3jiFJ0tBOsww6MAiVazk0PTpVHyw7J50V2O3ej622xmsygt8mPJu10NF7_3Ql-o9fxXiM2vEUBReHjk0KKd7PLkx59tm4YTHBxzpqBxAabVqqCfvgHvY1zCmU9zZAKjiAFFooulE0x5-RWz24Q9K_w9BKeLuHpx_A0LUPHL_d4HvmdVgHYAuTSCmuX_vz9H9mfqkOlvg</recordid><startdate>2024</startdate><enddate>2024</enddate><creator>Di Dalmazi, G.</creator><creator>Goi, J.</creator><creator>Burrello, J.</creator><creator>Tucci, L.</creator><creator>Cicero, A. F. G.</creator><creator>Mancusi, C.</creator><creator>Coletti Moia, E.</creator><creator>Iaccarino, G.</creator><creator>Borghi, C.</creator><creator>Muiesan, M. L.</creator><creator>Ferri, C.</creator><creator>Mulatero, P.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-1291-8906</orcidid></search><sort><creationdate>2024</creationdate><title>Screening of hypercortisolism among patients with hypertension: an Italian nationwide survey</title><author>Di Dalmazi, G. ; Goi, J. ; Burrello, J. ; Tucci, L. ; Cicero, A. F. G. ; Mancusi, C. ; Coletti Moia, E. ; Iaccarino, G. ; Borghi, C. ; Muiesan, M. L. ; Ferri, C. ; Mulatero, P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c426t-4c12395167c5a031327cd602f14c75d341176b2b63b1b0a8086944ad0e8a8093</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adrenocorticotropic hormone</topic><topic>Adult</topic><topic>Cortisol</topic><topic>Cushing syndrome</topic><topic>Cushing Syndrome - diagnosis</topic><topic>Cushing Syndrome - epidemiology</topic><topic>Cushing Syndrome - metabolism</topic><topic>Dexamethasone</topic><topic>Endocrinology</topic><topic>Female</topic><topic>Hormones</topic><topic>Humans</topic><topic>Hydrocortisone</topic><topic>Hydrocortisone - analysis</topic><topic>Hydrocortisone - metabolism</topic><topic>Hypertension</topic><topic>Hypertension - diagnosis</topic><topic>Hypertension - epidemiology</topic><topic>Internal Medicine</topic><topic>Italy - epidemiology</topic><topic>Male</topic><topic>Mass Screening - methods</topic><topic>Mass Screening - statistics & numerical data</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metabolic Diseases</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Original Article</topic><topic>Patients</topic><topic>Surveys</topic><topic>Surveys and Questionnaires</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Di Dalmazi, G.</creatorcontrib><creatorcontrib>Goi, J.</creatorcontrib><creatorcontrib>Burrello, J.</creatorcontrib><creatorcontrib>Tucci, L.</creatorcontrib><creatorcontrib>Cicero, A. F. G.</creatorcontrib><creatorcontrib>Mancusi, C.</creatorcontrib><creatorcontrib>Coletti Moia, E.</creatorcontrib><creatorcontrib>Iaccarino, G.</creatorcontrib><creatorcontrib>Borghi, C.</creatorcontrib><creatorcontrib>Muiesan, M. L.</creatorcontrib><creatorcontrib>Ferri, C.</creatorcontrib><creatorcontrib>Mulatero, P.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of endocrinological investigation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Di Dalmazi, G.</au><au>Goi, J.</au><au>Burrello, J.</au><au>Tucci, L.</au><au>Cicero, A. F. G.</au><au>Mancusi, C.</au><au>Coletti Moia, E.</au><au>Iaccarino, G.</au><au>Borghi, C.</au><au>Muiesan, M. L.</au><au>Ferri, C.</au><au>Mulatero, P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Screening of hypercortisolism among patients with hypertension: an Italian nationwide survey</atitle><jtitle>Journal of endocrinological investigation</jtitle><stitle>J Endocrinol Invest</stitle><addtitle>J Endocrinol Invest</addtitle><date>2024</date><risdate>2024</risdate><volume>47</volume><issue>12</issue><spage>3029</spage><epage>3038</epage><pages>3029-3038</pages><issn>1720-8386</issn><issn>0391-4097</issn><eissn>1720-8386</eissn><abstract>Purpose
Screening of Cushing Syndrome (CS) and Mild Autonomous Cortisol Secretion (MACS) in hypertensive patients is crucial for proper treatment. The aim of the study was to investigate screening and management of hypercortisolism among patients with hypertension in Italy.
Methods
A 10 item-questionnaire was delivered to referral centres of European and Italian Society of Hypertension (ESH and SIIA) in a nationwide survey. Data were analyzed according to type of centre (excellence
vs
non-excellence), geographical area, and medical specialty.
Results
Within 14 Italian regions, 82 centres (30% excellence, 78.790 patients during the last year, average 600 patients/year) participated to the survey. Internal medicine (44%) and cardiology (31%) were the most prevalent medical specialty. CS and MACS were diagnosed in 313 and 490 patients during the previous 5 years. The highest number of diagnoses was reported by internal medicine and excellence centres. Screening for hypercortisolism was reported by 77% in the presence of specific features of CS, 61% in resistant hypertension, and 38% in patients with adrenal mass. Among screening tests, the 24 h urinary free cortisol was the most used (66%), followed by morning cortisol and ACTH (54%), 1 mg-dexamethasone suppression test (49%), adrenal CT or MRI scans (12%), and late night salivary cortisol (11%). Awareness of referral centres with expertise in management of CS was reported by 67% of the participants, which reduced to 44% among non-excellence centres.
Conclusions
Current screening of hypercortisolism among hypertensive patients is unsatisfactory. Strategies tailored to different medical specialties and type of centres should be conceived.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>38913251</pmid><doi>10.1007/s40618-024-02387-2</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-1291-8906</orcidid><oa>free_for_read</oa></addata></record> |
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| issn | 1720-8386 0391-4097 1720-8386 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Adrenocorticotropic hormone Adult Cortisol Cushing syndrome Cushing Syndrome - diagnosis Cushing Syndrome - epidemiology Cushing Syndrome - metabolism Dexamethasone Endocrinology Female Hormones Humans Hydrocortisone Hydrocortisone - analysis Hydrocortisone - metabolism Hypertension Hypertension - diagnosis Hypertension - epidemiology Internal Medicine Italy - epidemiology Male Mass Screening - methods Mass Screening - statistics & numerical data Medicine Medicine & Public Health Metabolic Diseases Middle Aged Original Original Article Patients Surveys Surveys and Questionnaires |
| title | Screening of hypercortisolism among patients with hypertension: an Italian nationwide survey |
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