6965 Discrepancy As A Diagnostic Dilemma Between Patient-Reported And Physician-Reported Symptoms Of Cushing's Syndrome
Authors: Motomura Yuma , Urai Shin , Bando Hironori , Yamamoto Masaaki , Suzuki Masaki , Yamamoto Naoki , Iguchi Genzo , Ogawa Wataru , Fukuoka Hidenori 
Published: October 2024

Disclosure: Y. Motomura: None. S. Urai: None. H. Bando: None. M. Yamamoto: None. M. Suzuki: None. N. Yamamoto: None. G. Iguchi: None. W. Ogawa: None. H. Fukuoka: None.

Background: The early diagnosis and immediate treatment of Cushing’s syndrome (CS) are critical. However, the detection of CS is challenging because of its rarity and the fact that its symptoms are common in general diseases. Additionally, it remains unclear whether patients are adequately aware of their signs, symptoms, and comorbidities. Objective: To clarify the differences in manifestations that prevent the early diagnosis of CS in terms of patients’ recognition and physicians’ assessment of signs and symptoms. Patients and Methods: This was a single-center retrospective study of 52 patients with CS (16 with Cushing’s disease (CD) and 36 with adrenal CS (ACS)). At clinical diagnosis, the manifestations reported by the patient during a comprehensive interview and those reported by the physician through collaborative assessment with several board-certified endocrinologists were reviewed independently from the medical records as typical features, such as purple striae and proximal myopathy, and atypical features, such as hirsutism and hypertension. The duration from patients’ initial recognition of CS-related manifestations to diagnosis and the number of medical institutions before diagnosis were also reviewed. The correlations and differences between the patient- and physician-reported manifestations were analyzed. Results: The number of medical facilities visited by patients before diagnosis was 3.0 [2.0-5.0]. The duration from the patients’ initial recognition of CS-related manifestations to diagnosis was 44.0 [13.3-125.3] months. A positive correlation was observed between the total number of manifestations in atypical features reported by patients or physicians (r =0.62, P &lt;0.01) but not in typical features (r =-0.20, P =0.16). The total number of manifestations in typical features reported by patients was less than that reported by physicians (P &lt;0.01). Similarly, the frequencies of each typical feature reported by patients, except for proximal myopathies, were lower than those reported by physicians, resulting in discrepancies between patient- and physician-reported manifestations in typical features. In contrast, there were no differences in atypical features, except for glucose metabolism impairment or osteoporosis, between patient- and physician-reported manifestations. The concordance between patient- and physician-reported manifestations as typical features was not associated with the subtypes of CD and ACS, levels of urinary free cortisol, or serum cortisol levels after loading with low-dose dexamethasone. Conclusions: Regardless of the severity of CS, patients often struggle to convey the typical features of CS that are crucial for suspicion, resulting in challenges in the early diagnosis of CS.

Presentation: 6/2/2024