Cushing’s syndrome greatly raises risk of hospitalization for infections
Study: Concern remains even after the disease goes into remission
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Serious infections requiring hospitalization remain a long-term concern in Cushing’s syndrome, even after the disease goes into remission, according to a real-world study that followed more than 600 patients for about 13 years.
Researchers found that adults with Cushing’s syndrome were more than twice as likely as matched people without the disease to be hospitalized because of an infection. The risk was nearly four times higher among those with Cushing’s disease.
Although the risk declined after patients achieved remission, it remained significantly elevated, supporting the need for “ongoing infection surveillance and preventive measures,” researchers wrote.
The study, “Risk of Infection-Related Hospitalization Is More Than Doubled in Cushing’s Syndrome vs Matched Controls,” was published in The American Journal of Medicine.
Excess cortisol can weaken immune system, set stage for infections
Cushing’s syndrome occurs when the body is exposed to excessive amounts of the hormone cortisol, a condition known as hypercortisolism. In endogenous Cushing’s syndrome, the body produces too much cortisol on its own, most commonly because of a tumor in the brain’s pituitary gland (a condition known as Cushing’s disease) or a tumor affecting the adrenal glands atop the kidney (adrenal Cushing’s syndrome).
Over time, excess cortisol can cause a wide range of Cushing’s symptoms and complications, including weight gain, skin changes, high blood pressure, and diabetes. It may also weaken the immune system, making people more vulnerable to bacterial, viral, and fungal infections, as well as opportunistic infections that mainly affect people with weakened immune systems. Hypercortisolism may further increase infection severity by raising blood sugar levels, thinning the skin, and slowing wound healing.
Although the link between hypercortisolism and infection is well established, “the epidemiology of infection-related hospitalization in endogenous Cushing’s syndrome remains incompletely characterized,” the researchers wrote. “No prior study has comprehensively evaluated infection-related hospitalization in a large Cushing’s syndrome [group] compared with matched controls.”
Respiratory infections most common reason for hospitalization
To address this gap, researchers analyzed health records from 609 adults with endogenous Cushing’s syndrome and 3,018 age- and sex-matched people without the disease. Data came from Clalit Health Services (CHS), a large healthcare organization, and infection-related hospitalizations were tracked from diagnosis until death, disenrollment from CHS, or the end of follow-up.
People with Cushing’s had a mean age at diagnosis of 48.1, and 65% were women. Overall, 251 (41.2%) had Cushing’s disease, 200 (32.8%) had adrenal Cushing’s syndrome, and in 158 (25.9%) the underlying cause could not be definitively determined.
Their mean body mass index (BMI), a measure of body fat based on height and weight, was 30.9, which falls within the obesity range. As expected, complications commonly associated with hypercortisolism, including high blood pressure and diabetes, were more common than in matched controls.
Over an average follow-up of about 13 years, 14.1% of people with Cushing’s syndrome were hospitalized for infection, compared with 5.9% of matched controls. Overall, people with Cushing’s syndrome were 2.5 times more likely to require infection-related hospitalization.
The increased risk was seen regardless of the underlying cause of the disease, although it was greater in people with Cushing’s disease, who were 3.8 times more likely than matched controls to be hospitalized because of an infection. In people with adrenal Cushing’s syndrome, the risk was 2.3 times higher than in matched controls.
Our findings support heightened vigilance and infection prevention strategies at diagnosis and continued monitoring after remission.
Respiratory infections were the most common reason for hospitalization, followed by urinary tract, gastrointestinal, and skin infections. Opportunistic infections represented a significantly larger proportion of identified pathogens in people with Cushing’s syndrome than in matched controls (12.5% vs. 5.6%)
Among the 288 patients who achieved remission within two years of Cushing’s diagnosis, 11.1% were later hospitalized because of an infection, compared with 4.6% of matched controls. Even after remission, people with Cushing’s syndrome remained 2.5 times more likely to require infection-related hospitalization.
Patients whose disease did not go into remission had an even higher infection-related hospitalization rate compared with controls (17.6% vs. 5.7%), corresponding to a 3.2 times greater risk. However, the difference in infection risk between patients who achieved remission and those who did not was not statistically significant.
After accounting for multiple factors, older age and higher BMI were identified as the only two factors independently associated with a greater risk of infection-related hospitalization.
“Our findings support heightened vigilance and infection prevention strategies at diagnosis and continued monitoring after remission,” the researchers wrote. People with Cushing’s disease are at the highest risk of serious infections, including those older than 55, individuals with multiple other health conditions, and those with a BMI above 25, and may benefit most from targeted infection prevention strategies, they added
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