{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:12:13Z","timestamp":1792195933385,"version":"4.4.0"},"reference-count":30,"publisher":"The Endocrine Society","issue":"5","license":[{"start":{"date-parts":[[2021,1,31]],"date-time":"2021-01-31T00:00:00Z","timestamp":1612051200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>Cushing syndrome (CS) results in significant morbidity and mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To study acute and life-threatening complications in patients with active CS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed a retrospective cohort study using inpatient and outpatient records of patients with CS in a tertiary center. A total of 242 patients with CS were included, including 213 with benign CS (pituitary n\u2005=\u2005101, adrenal n\u2005=\u200599, ectopic n\u2005=\u200513), and 29 with malignant disease. We collected acute complications necessitating hospitalization, from appearance of first symptoms of hypercortisolism until 1 year after biochemical remission. Mortality data were obtained from the national registry. Baseline factors relating to and predicting acute complications were tested using uni- and multivariate analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The prevalence of acute complications was 62% in patients with benign pituitary CS, 40% in patients with benign adrenal CS, and 100% in patients with ectopic CS. Complications observed in patients with benign CS included infections (25%), thromboembolic events (17%), hypokalemia (13%), hypertensive crises (9%), cardiac arrhythmias (5%), and acute coronary events (3%). Among these patients, 23% had already been hospitalized for acute complications before CS was suspected, and half of complications occurred after the first surgery. Glycated hemoglobin (HbA1c) and 24-hour urinary free cortisol positively correlated with the number of acute complications per patient. Patients with malignant disease had significantly higher rates of acute complications. Mortality during the observation period was 2.8% and 59% in benign and malignant CS, respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This analysis highlights the whole spectrum of acute and life-threatening complications in CS, and their high prevalence even before disease diagnosis and after successful surgery.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgab058","type":"journal-article","created":{"date-parts":[[2021,1,31]],"date-time":"2021-01-31T11:56:33Z","timestamp":1612094193000},"page":"e2035-e2046","source":"Crossref","is-referenced-by-count":51,"title":["Acute and Life-threatening Complications in Cushing Syndrome: Prevalence, Predictors, and Mortality"],"prefix":"10.1210","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7972-7610","authenticated-orcid":false,"given":"Marie Helene","family":"Schernthaner-Reiter","sequence":"first","affiliation":[{"name":"Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18\u201320, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Siess","sequence":"additional","affiliation":[{"name":"Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18\u201320, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Micko","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18\u201320, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Zauner","sequence":"additional","affiliation":[{"name":"Clinical Division of Gastroenterology and Hepatology, Intensive Care Unit, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18\u201320, Vienna; Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Wolfsberger","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18\u201320, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Scheuba","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medical University of Vienna, Waehringer Guertel 18\u201320, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Riss","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medical University of Vienna, Waehringer Guertel 18\u201320, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Engelbert","family":"Knosp","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18\u201320, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Kautzky-Willer","sequence":"additional","affiliation":[{"name":"Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18\u201320, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton","family":"Luger","sequence":"additional","affiliation":[{"name":"Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18\u201320, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1918-1959","authenticated-orcid":false,"given":"Greisa","family":"Vila","sequence":"additional","affiliation":[{"name":"Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18\u201320, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2021,1,31]]},"reference":[{"issue":"9996","key":"2021122205022978700_CIT0001","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1016\/S0140-6736(14)61375-1","article-title":"Cushing\u2019s syndrome","volume":"386","author":"Lacroix","year":"2015","journal-title":"Lancet."},{"issue":"7","key":"2021122205022978700_CIT0002","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":"1","key":"2021122205022978700_CIT0003","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/s12020-018-1819-6","article-title":"Factors predicting long-term comorbidities in patients with Cushing\u2019s syndrome in remission","volume":"64","author":"Schernthaner-Reiter","year":"2019","journal-title":"Endocrine."},{"issue":"3","key":"2021122205022978700_CIT0004","doi-asserted-by":"crossref","DOI":"10.1210\/clinem\/dgz136","article-title":"Time to diagnosis in Cushing\u2019s syndrome: a meta-analysis based on 5367 patients","volume":"105","author":"Rubinstein","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"2021122205022978700_CIT0005","doi-asserted-by":"crossref","first-page":"2375","DOI":"10.1210\/jc.2018-02524","article-title":"Overall and disease-specific mortality in patients with Cushing disease: a swedish nationwide study","volume":"104","author":"Ragnarsson","year":"2019","journal-title":"J Clin Endocrinol Metab."},{"issue":"4","key":"2021122205022978700_CIT0006","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1210\/jc.2011-2957","article-title":"Outcome of Cushing\u2019s disease following transsphenoidal surgery in a single center over 20 years","volume":"97","author":"Hassan-Smith","year":"2012","journal-title":"J Clin Endocrinol Metab."},{"issue":"2","key":"2021122205022978700_CIT0007","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.ecl.2018.02.005","article-title":"Mortality in Patients with Endogenous Cushing\u2019s Syndrome","volume":"47","author":"Javanmard","year":"2018","journal-title":"Endocrinol Metab Clin North Am."},{"issue":"4","key":"2021122205022978700_CIT0008","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":"6","key":"2021122205022978700_CIT0009","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":"5","key":"2021122205022978700_CIT0010","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":"2021122205022978700_CIT0011","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1530\/EJE-19-0464","article-title":"High mortality within 90 days of diagnosis in patients with Cushing\u2019s syndrome: results from the ERCUSYN 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