J Korean Soc Endocrinol.  2000 Mar;15(1):31-45.

The Incidence and Clinical Characteristics of Cushing's Syndrome in Korea

• The Korean Society of Endocrinology, The Survey Committee for Endocrine Disease in Korea

Abstract

BACKGROUND
Cushing's syndrome is a relatively well understood syndrome. In Korea, there was no large scaled epidemiological report for etiology, clinical manifestation and results of treatment for Cushing's syndrome so far. This study was undertaken to elucidate the clinical characteristics of Cushing's syndrome in Korea by the survey committee for endocrine disease in Korean society of endocrinology.
METHODS
For the case collection, we developed the case analysis protocol and computer program. And then we sent those form and program to 51 hospitals lacated in all over the country except Jeju-Do. Finally we collected 180 cases of Cushing's syndrome newly diagnosed from Jan. 1st, 1988 to Dec. 31st, 1993 from 28 hospitals. In this study, we excluded the patients with iatrogenic Cushing's syndrome.
RESULTS
1. If we collected all the cases in Korea, 0.84 new cases/million was diagnosed annually. The incidence was 3.5 times greater in women than in men, and the most frequent age of onset was the fourth decade. 2. Pituitary microadenoma and adrenal adenoma were the major causes (43.3%, 41.7% respectively). The ectopic Cushing's syndrome had very low incidence (0.6%) then other western countries. 3. Liddle's low dose dexamethasone suppression test, 24hr urine free cortisol level and 1mg overnight dexamethasone suppression test as a screening tests showed good sensitivity (98.1%, 94.3%, 96.3% respectively). 4. Both of 8 mg overnight dexamethasone suppression test and basal plasma ACTH level as differential test of Cushing's disease from adrenal Cushing's syndromes showed good specificity (90.6%, 100% respectively) but relatively low sensitivity (60.7%, 26.3% respectively). 5. Combination of both 8 mg overnight dexamethasone suppression test and basal plasma ACTH level improved the sensitivity (75.0%) and specificity (94.7%) as differential tests. 6. Treatments depended on the etiology. Surgery was the best choice when it could be performed. Radiotherapy and medical treatments were performed as isolated or combined modality but results were poor.
CONCLUSION
Cushing's syndrome in Korea were not significantly different from western cases except that adrenal adenomas were more frequent. Ectopic Cushing's syndrome and Cushing's disease must be attentioned for diagnosis and proper management. Early and exact diagnosis process will improve the morbidity, mortality and life quality of patients.

MeSH Terms

Adenoma
Adrenocorticotropic Hormone
Age of Onset
Cushing Syndrome*
Dexamethasone
Diagnosis
Endocrine System Diseases
Endocrinology
Epidemiology
Female
Humans
Hydrocortisone
Incidence*
Jeju-do
Korea*
Male
Mass Screening
Mortality
Plasma
Quality of Life
Radiotherapy
Sensitivity and Specificity
Adrenocorticotropic Hormone
Dexamethasone
Hydrocortisone