Clinical features, comorbidities, and therapeutic outcomes of Cushing syndrome: a retrospective multicenter study from Saudi Arabia

Abstract

Cushing syndrome (CS) is associated with significant morbidity and mortality, but data from the Middle East, including Saudi Arabia, are limited. This study aimed to characterize the demographics, clinical features, comorbidities, diagnostic findings, treatments, and outcomes in a Saudi Arabian multicenter tertiary-referral cohort. In this retrospective multicenter study, 146 patients with confirmed CS were included. Demographics, clinical features, laboratory and imaging results, treatments, and outcomes were collected and analyzed according to etiological subtype. Among 146 patients (114 women, 32 men; mean age at last recorded follow-up or data abstraction, 42.2 ± 14.7 years), pituitary CS was the most common etiology (61.0%). The mean diagnostic delay was 7.5 years (median 5 years). Hypertension (62.3%) and dysglycemia (67.1%) were prevalent. Among the 88 patients who underwent bone mineral density assessment, 71.6% had abnormal bone health; this selected-subgroup estimate should not be generalized to the entire cohort. Hypokalemia was frequent in ectopic CS (84.6%). Treatment was etiology-specific: 85.4% of the patients with pituitary CS underwent transsphenoidal surgery (TSS), and 87.9% of patients with adrenal CS who underwent adrenalectomy had a unilateral procedure. Crude mortality was 5.1% (7/138 patients with known vital status), remission was documented in 66.9% (93/139 with recorded outcomes), and recurrence after a documented remission occurred in 12 patients. In this Saudi Arabian multicenter tertiary-referral cohort, CS predominantly affects women and is most frequently attributable to pituitary CS. Diagnostic delay remains prolonged despite advances in diagnosis and management. Descriptive treatment outcomes were broadly consistent with international experience; crude mortality was 5.1% among patients with known vital status.