{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T18:12:47Z","timestamp":1793643167665,"version":"4.5.1"},"reference-count":27,"publisher":"The Endocrine Society","issue":"3","license":[{"start":{"date-parts":[[2020,10,19]],"date-time":"2020-10-19T00:00:00Z","timestamp":1603065600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100003646","name":"National Health Insurance Service","doi-asserted-by":"publisher","award":["NHIS-2019-4-007"],"award-info":[{"award-number":["NHIS-2019-4-007"]}],"id":[{"id":"10.13039\/501100003646","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>Adrenal Cushing syndrome (CS) is a major subtype of CS and has a high surgical cure rate. However, only a few studies have investigated the epidemiology and long-term outcomes of adrenal CS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>We aimed to investigate the nationwide epidemiology, long-term prognosis, and postoperative glucocorticoid replacement therapies of adrenal CS in Korea.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Retrospective cohort study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>A nationwide claim database.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients<\/jats:title>\n                  <jats:p>Adrenal CS patients who were defined as having undergone adrenalectomy, a diagnosis code of CS, and not having pituitary gland surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main Outcome Measures<\/jats:title>\n                  <jats:p>Crude incidence and age-standardized incidence rates, long-term mortality, comorbidities diagnosed preoperatively or developed postoperatively, and the pattern of postoperative glucocorticoid replacement therapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>From 2002 to 2017, there were a total of 1199 new adrenal CS patients, including 72 patients with adrenocortical carcinoma (malignant adrenal CS), in Korea. The crude and age-standardized incidence rates were 1.51 and 1.27 per million person-years, respectively. The overall standardized mortality ratio was 3.0 (95% confidence interval [CI], 2.4-3.7) for benign adrenal CS and 13.1 (95% CI, 7.6-18.6) for malignant adrenal CS. Adrenal CS patients had a high risk of having coronary artery disease, stroke, metabolic diseases, and depression. A similar proportion of patients were diagnosed with these comorbidities both preoperatively and postoperatively, suggesting a significant residual risk even after adrenalectomy. The median time of postoperative glucocorticoid replacement therapy was 10.1 months, and the major types of glucocorticoids used were prednisolone (66.6%) and hydrocortisone (22.4%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Adrenal CS is associated with multiple comorbidities even after treatment, which necessitates meticulous postoperative care.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgaa752","type":"journal-article","created":{"date-parts":[[2020,10,19]],"date-time":"2020-10-19T22:43:27Z","timestamp":1603147407000},"page":"e1362-e1372","source":"Crossref","is-referenced-by-count":38,"title":["Epidemiology and Comorbidity of Adrenal Cushing Syndrome: A Nationwide Cohort Study"],"prefix":"10.1210","volume":"106","author":[{"given":"Chang Ho","family":"Ahn","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea"},{"name":"Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1932-0234","authenticated-orcid":false,"given":"Jung Hee","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea"},{"name":"Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Man Young","family":"Park","sequence":"additional","affiliation":[{"name":"Korea Institute of Oriental Medicine, Daejeon, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Wan","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea"},{"name":"Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2020,10,19]]},"reference":[{"issue":"9522","key":"2021122117325100100_CIT0001","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.1016\/S0140-6736(06)68699-6","article-title":"Cushing\u2019s syndrome","volume":"367","author":"Newell-Price","year":"2006","journal-title":"Lancet."},{"issue":"4","key":"2021122117325100100_CIT0002","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1111\/j.1365-2265.2011.04124.x","article-title":"Mortality and morbidity in Cushing\u2019s syndrome in New Zealand","volume":"75","author":"Bolland","year":"2011","journal-title":"Clin Endocrinol (Oxf)."},{"issue":"1","key":"2021122117325100100_CIT0003","first-page":"117","article-title":"Incidence and late prognosis of Cushing\u2019s syndrome: a population-based study","volume":"86","author":"Lindholm","year":"2001","journal-title":"J Clin Endocrinol Metab."},{"issue":"5","key":"2021122117325100100_CIT0004","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1530\/EJE-13-0569","article-title":"Mortality in Cushing\u2019s syndrome: systematic analysis of a large series with prolonged follow-up","volume":"169","author":"Ntali","year":"2013","journal-title":"Eur J Endocrinol."},{"issue":"5","key":"2021122117325100100_CIT0005","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1046\/j.1365-2796.1999.00483.x","article-title":"The survival and well-being of patients treated for Cushing\u2019s syndrome","volume":"245","author":"Pikkarainen","year":"1999","journal-title":"J Intern Med."},{"issue":"5","key":"2021122117325100100_CIT0006","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1530\/EJE-13-0320","article-title":"Mortality in Cushing\u2019s syndrome: data from 386 patients from a single tertiary referral center","volume":"169","author":"Yaneva","year":"2013","journal-title":"Eur J Endocrinol."},{"issue":"8","key":"2021122117325100100_CIT0007","first-page":"2664","article-title":"Persistence of increased cardiovascular risk in patients with Cushing\u2019s disease after five years of successful cure","volume":"84","author":"Colao","year":"1999","journal-title":"J Clin Endocrinol Metab."},{"issue":"4","key":"2021122117325100100_CIT0008","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1210\/jc.2014-3632","article-title":"Time to recovery of adrenal function after curative surgery for Cushing\u2019s syndrome depends on etiology","volume":"100","author":"Berr","year":"2015","journal-title":"J Clin Endocrinol Metab."},{"issue":"2","key":"2021122117325100100_CIT0009","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1111\/j.1365-2265.1984.tb00078.x","article-title":"Long-term results of adrenal surgery in patients with Cushing\u2019s syndrome due to adrenocortical adenoma","volume":"20","author":"V\u00e4lim\u00e4ki","year":"1984","journal-title":"Clin Endocrinol (Oxf)."},{"issue":"6","key":"2021122117325100100_CIT0010","first-page":"1085","article-title":"Time to recovery of the hypothalamic-pituitary-adrenal axis after curative resection of adrenal tumors in patients with Cushing\u2019s syndrome","volume":"108","author":"Doherty","year":"1990","journal-title":"Surgery."},{"issue":"1","key":"2021122117325100100_CIT0011","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1093\/ije\/dyt228","article-title":"Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES)","volume":"43","author":"Kweon","year":"2014","journal-title":"Int J Epidemiol."},{"key":"2021122117325100100_CIT0012","volume-title":"Age standardization of rates: a new WHO standard.","author":"Ahmad","year":"2001"},{"issue":"2","key":"2021122117325100100_CIT0013","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1111\/cen.14014","article-title":"The incidence of endogenous Cushing\u2019s syndrome in the modern era","volume":"91","author":"Wengander","year":"2019","journal-title":"Clin Endocrinol (Oxf)."},{"issue":"2","key":"2021122117325100100_CIT0014","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1530\/EJE-16-0467","article-title":"Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors","volume":"175","author":"Fassnacht","year":"2016","journal-title":"Eur J Endocrinol."},{"issue":"9","key":"2021122117325100100_CIT0015","doi-asserted-by":"crossref","first-page":"4106","DOI":"10.1210\/jc.2010-0457","article-title":"Approach to the patient with an adrenal incidentaloma","volume":"95","author":"Nieman","year":"2010","journal-title":"J Clin Endocrinol Metab."},{"issue":"2","key":"2021122117325100100_CIT0016","doi-asserted-by":"crossref","first-page":"200","DOI":"10.3803\/EnM.2017.32.2.200","article-title":"Clinical guidelines for the management of adrenal incidentaloma","volume":"32","author":"Lee","year":"2017","journal-title":"Endocrinol Metab (Seoul)."},{"issue":"1","key":"2021122117325100100_CIT0017","first-page":"31","article-title":"The incidence and clinical characteristics of Cushing\u2019s syndrome in Korea","volume":"15","author":"The Survey Committee for Endocrine Disease in Korea","year":"2000","journal-title":"J Korean Soc Endocrinol."},{"issue":"3","key":"2021122117325100100_CIT0018","doi-asserted-by":"crossref","first-page":"297","DOI":"10.3803\/EnM.2015.30.3.297","article-title":"Limited diagnostic utility of plasma adrenocorticotropic hormone for differentiation between adrenal Cushing syndrome and Cushing disease","volume":"30","author":"Hong","year":"2015","journal-title":"Endocrinol Metab (Seoul)."},{"issue":"5","key":"2021122117325100100_CIT0019","doi-asserted-by":"crossref","first-page":"536","DOI":"10.3348\/kjr.2012.13.5.536","article-title":"Trends of CT use in the adult emergency department in a tertiary academic hospital of Korea during 2001-2010","volume":"13","author":"Oh","year":"2012","journal-title":"Korean J Radiol."},{"issue":"7","key":"2021122117325100100_CIT0020","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/S2213-8587(16)30005-5","article-title":"Mortality in patients with Cushing\u2019s disease more than 10 years after remission: a multicentre, multinational, retrospective cohort study","volume":"4","author":"Clayton","year":"2016","journal-title":"Lancet Diabetes Endocrinol."},{"issue":"2","key":"2021122117325100100_CIT0021","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1210\/er.2013-1029","article-title":"Adrenocortical carcinoma","volume":"35","author":"Else","year":"2014","journal-title":"Endocr Rev."},{"issue":"7","key":"2021122117325100100_CIT0022","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/S2213-8587(16)00086-3","article-title":"Complications of Cushing\u2019s syndrome: state of the art","volume":"4","author":"Pivonello","year":"2016","journal-title":"Lancet Diabetes Endocrinol."},{"issue":"12","key":"2021122117325100100_CIT0023","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1016\/S0735-1097(03)00493-5","article-title":"Left ventricular structural and functional characteristics in Cushing\u2019s syndrome","volume":"41","author":"Muiesan","year":"2003","journal-title":"J Am Coll Cardiol."},{"issue":"6","key":"2021122117325100100_CIT0024","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1055\/s-2006-944545","article-title":"Patients with Cushing\u2019s syndrome have increased intimal media thickness at different vascular levels: comparison with a population matched for similar cardiovascular risk factors","volume":"38","author":"Albiger","year":"2006","journal-title":"Horm Metab Res."},{"issue":"6","key":"2021122117325100100_CIT0025","doi-asserted-by":"crossref","first-page":"2277","DOI":"10.1210\/jc.2012-3582","article-title":"Multisystem morbidity and mortality in Cushing\u2019s syndrome: a cohort study","volume":"98","author":"Dekkers","year":"2013","journal-title":"J Clin Endocrinol Metab."},{"issue":"6","key":"2021122117325100100_CIT0026","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1111\/cen.13803","article-title":"Extensive clinical experience: hypothalamic-pituitary-adrenal axis recovery after adrenalectomy for corticotropin-independent cortisol excess","volume":"89","author":"Hurtado","year":"2018","journal-title":"Clin Endocrinol (Oxf)."},{"issue":"8","key":"2021122117325100100_CIT0027","doi-asserted-by":"crossref","first-page":"2637","DOI":"10.1210\/jc.2014-1401","article-title":"Adrenal function after adrenalectomy for subclinical hypercortisolism and Cushing\u2019s syndrome: a systematic review of the literature","volume":"99","author":"Di Dalmazi","year":"2014","journal-title":"J Clin Endocrinol Metab."}],"container-title":["The Journal of Clinical Endocrinology &amp; Metabolism"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jcem\/advance-article-pdf\/doi\/10.1210\/clinem\/dgaa752\/33948536\/dgaa752.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/106\/3\/e1362\/41831601\/dgaa752.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/106\/3\/e1362\/41831601\/dgaa752.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,21]],"date-time":"2021-12-21T17:47:26Z","timestamp":1640108846000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcem\/article\/106\/3\/e1362\/5930839"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,19]]},"references-count":27,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,10,19]]},"published-print":{"date-parts":[[2021,3,8]]}},"URL":"https:\/\/doi.org\/10.1210\/clinem\/dgaa752","relation":{},"ISSN":["0021-972X","1945-7197"],"issn-type":[{"value":"0021-972X","type":"print"},{"value":"1945-7197","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,3,1]]},"published":{"date-parts":[[2020,10,19]]}}}