{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:47:19Z","timestamp":1787021239910,"version":"build-2736575974"},"reference-count":41,"publisher":"The Endocrine Society","issue":"8","license":[{"start":{"date-parts":[[2020,5,21]],"date-time":"2020-05-21T00:00:00Z","timestamp":1590019200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"ALF-agreement","award":["ALFGBG-593301"],"award-info":[{"award-number":["ALFGBG-593301"]}]},{"name":"Gothenburg Society of Medicine"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Whether multisystem morbidity in Cushing\u2019s disease (CD) remains elevated during long-term remission is still undetermined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate comorbidities in patients with CD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, Setting, and Patients<\/jats:title>\n                    <jats:p>A retrospective, nationwide study of patients with CD identified in the Swedish National Patient Register between 1987 and 2013. Individual medical records were reviewed to verify diagnosis and remission status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes<\/jats:title>\n                    <jats:p>Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were calculated by using the Swedish general population as reference. Comorbidities were investigated during three different time periods: (i) during the 3 years before diagnosis, (ii) from diagnosis to 1 year after remission, and (iii) during long-term remission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 502 patients with confirmed CD, of whom 419 were in remission for a median of 10 (interquartile range 4 to 21) years. SIRs (95% CI) for myocardial infarction (4.4; 1.2 to 11.4), fractures (4.9; 2.7 to 8.3), and deep vein thrombosis (13.8; 3.8 to 35.3) were increased during the 3-year period before diagnosis. From diagnosis until 1 year after remission, SIRs (95% CI were increased for thromboembolism (18.3; 7.9 to 36.0), stroke (4.9; 1.3 to 12.5), and sepsis (13.6; 3.7 to 34.8). SIRs for thromboembolism (4.9; 2.6 to 8.4), stroke (3.1; 1.8 to 4.9), and sepsis (6.0; 3.1 to 10.6) remained increased during long-term remission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients with CD have an increased incidence of stroke, thromboembolism, and sepsis even after remission, emphasizing the importance of early identification and management of risk factors for these comorbidities during long-term follow-up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgaa291","type":"journal-article","created":{"date-parts":[[2020,5,21]],"date-time":"2020-05-21T10:48:10Z","timestamp":1590058090000},"page":"2616-2624","source":"Crossref","is-referenced-by-count":67,"title":["Excess Morbidity Persists in Patients With Cushing\u2019s Disease During Long-term Remission: A Swedish Nationwide Study"],"prefix":"10.1210","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1163-862X","authenticated-orcid":false,"given":"Eleni","family":"Papakokkinou","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"},{"name":"The Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel S","family":"Olsson","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"},{"name":"The Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Chantzichristos","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"},{"name":"The Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6471-9503","authenticated-orcid":false,"given":"Per","family":"Dahlqvist","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elin","family":"Segerstedt","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommy","family":"Olsson","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Petersson","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet and The Department of Endocrinology, Metabolism and Diabetology, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarina","family":"Berinder","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet and The Department of Endocrinology, Metabolism and Diabetology, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9193-2860","authenticated-orcid":false,"given":"Sophie","family":"Bensing","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet and The Department of Endocrinology, Metabolism and Diabetology, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"H\u00f6ybye","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet and The Department of Endocrinology, Metabolism and Diabetology, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Britt","family":"Ed\u00e9n-Engstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences; Endocrinology, Diabetes and Metabolism, Uppsala University Hospital, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia","family":"Burman","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sk\u00e5ne University Hospital, University of Lund, Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenza","family":"Bonelli","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sk\u00e5ne University Hospital, University of Lund, Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Follin","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sk\u00e5ne University Hospital, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Petranek","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sk\u00e5ne University Hospital, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva Marie","family":"Erfurth","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sk\u00e5ne University Hospital, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4061-6830","authenticated-orcid":false,"given":"Jeanette","family":"Wahlberg","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Department of Medical and Health Sciences, Link\u00f6ping University, Link\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertil","family":"Ekman","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Department of Medical and Health Sciences, Link\u00f6ping University, Link\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna-Karin","family":"\u00c5kerman","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Health and Medical Sciences, \u00d6rebro University, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Schwarcz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Health and Medical Sciences, \u00d6rebro University, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ing-Liss","family":"Bryngelsson","sequence":"additional","affiliation":[{"name":"Department of Occupational and Environmental Medicine, University Hospital, Faculty of Medicine and Health, \u00d6rebro University, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3484-8440","authenticated-orcid":false,"given":"Gudmundur","family":"Johannsson","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"},{"name":"The Department of Endocrinology, 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