库欣综合征的诊断难题:患者报告与医生评估表现之间的差异。

IF 3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Endocrine Pub Date : 2024-10-01 Epub Date: 2024-06-25 DOI:10.1007/s12020-024-03935-9
Yuma Motomura, Shin Urai, Hironori Bando, Masaaki Yamamoto, Masaki Suzuki, Naoki Yamamoto, Genzo Iguchi, Wataru Ogawa, Hidenori Fukuoka
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引用次数: 0

摘要

目的:库欣综合征(CS)的早期诊断和及时治疗对改善预后至关重要,但仍是一项挑战。然而,很少有全面的报告关注这一问题或调查患者报告的症状表现与医生评估的症状表现是否一致。本研究旨在阐明患者报告的与医生评估的 CS 体征和症状表现之间的差异,这些差异阻碍了早期诊断:这项单中心回顾性研究纳入了 52 名 CS 患者(16 名库欣氏症患者和 36 名肾上腺 CS 患者)。临床诊断后,我们使用病历对患者报告和医生评估的典型表现(如紫纹和近端肌病)和非特异性特征(如多毛和高血压)进行了独立审查。然后分析了患者报告的表现和医生评估的表现之间的相关性和差异:结果:我们观察到,患者报告的非特异性特征表现总数与医生评估的表现总数呈正相关,但典型特征表现总数与医生评估的总数不呈正相关。此外,就典型特征而言,患者报告的表现少于医生评估的表现,这导致了两组之间的差异。相比之下,患者报告的表现与医生评估的表现在大多数非特异性特征方面没有差异。值得注意的是,患者报告的典型特征表现与医生评估的典型特征表现之间的一致性与尿游离皮质醇水平无关:结论:无论疾病的严重程度如何,患者通常不会主诉 CS 的典型特征,而这些特征对于诊断至关重要。
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Diagnostic dilemma in Cushing's syndrome: discrepancy between patient-reported and physician-assessed manifestations.

Purpose: Early diagnosis and immediate treatment of Cushing's syndrome (CS) are critical for a better prognosis but remain a challenge. However, few comprehensive reports have focused on this issue or investigated whether patient-reported manifestations are consistent with physician-assessed symptoms of CS. This study aimed to clarify the differences in patient-reported and physician-assessed manifestations of signs and symptoms of CS that prevent early diagnosis.

Methods: This single-center retrospective study included 52 patients with CS (16 with Cushing's disease and 36 with adrenal CS). Upon clinical diagnosis, medical records were used to independently review the patient-reported and physician-assessed manifestations of typical (such as purple striae and proximal myopathy) and nonspecific features (such as hirsutism and hypertension). The correlations and differences between the patient-reported and physician-assessed manifestations were then analyzed.

Results: We observed a positive correlation between the total number of manifestations of nonspecific features reported by patients and those assessed by physicians, but not for typical features. Moreover, manifestations reported by the patients were less frequent than those assessed by physicians for typical features, leading to discrepancies between the two groups. In contrast, there were no differences in most nonspecific features between the patient-reported and physician-assessed manifestations. Notably, the concordance between patient-reported and physician-assessed manifestations of typical features was not associated with urinary free cortisol levels.

Conclusion: Regardless of disease severity, patients often do not complain of the typical features of CS that are crucial for formulating a diagnosis.

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来源期刊
Endocrine
Endocrine ENDOCRINOLOGY & METABOLISM-
CiteScore
6.50
自引率
5.40%
发文量
295
审稿时长
1.5 months
期刊介绍: Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.
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