Relative risk (RR) in patients with versus without Cushing's disease (CD) of dyads of conditions selected by clinical content expert opinion
| Order | Condition 1 | Condition 2 | Development data set | Validation data set | ||
|---|---|---|---|---|---|---|
| RR | CD | Non-CD | RR | |||
| Frequency (%) | Frequency (%) | |||||
| 1 | Hypertension | Hirsutism | 70.0 | 49 (2.613) | 0 (0.000) | ∞ |
| 2 | Serious infections | Adrenal mass | ∞ | 42 (2.240) | 0 (0.000) | ∞ |
| 3 | Type 2 diabetes | Hirsutism | 62.0 | 30 (1.600) | 0 (0.000) | ∞ |
| 4 | Uncontrolled type 2 diabetes | Premature menopause | 44.0 | 15 (0.800) | 0 (0.000) | ∞ |
| 5 | Weakness/fatigue | Hirsutism | 35.0 | 64 (3.413) | 1 (0.027) | 128.0 |
| 6 | Hyperlipidaemia | Adrenal mass | ∞ | 56 (2.987) | 1 (0027) | 112.0 |
| 7 | Type 2 diabetes | Adrenal mass | ∞ | 52 (2.773) | 1 (0.027) | 104.0 |
| 8 | Psychiatric disorders | Hirsutism | 43.0 | 49 (2.613) | 1 (0.027) | 98.0 |
| 9 | Serious infections | Hirsutism | ∞ | 44 (2.347) | 1 (0.027) | 88.0 |
| 10 | Sleep disorders | Adrenal mass | ∞ | 35 (1.867) | 1 (0.027) | 70.0 |
| 11 | Uncontrolled type 2 diabetes | Hypokalaemia | 15.0 | 32 (1.707) | 1 (0.027) | 64.0 |
| 12 | Psychiatric disorders | Adrenal mass | ∞ | 63 (3.360) | 2 (0.053) | 63.0 |
| 13 | Weakness/fatigue | Adrenal mass | ∞ | 56 (2.987) | 2 (0.053) | 56.0 |
| 14 | Obesity | Osteoporosis | 10.0 | 26 (1.387) | 1 (0.027) | 52.0 |
| 15 | Metabolic syndrome/impaired glucose tolerance /pre-diabetes | Vertebral, long bone, rib, pelvic and foot fracture | 38.0 | 18 (0.960) | 1 (0.027) | 36.0 |
| 16 | Weakness/fatigue | Female balding | 15.3 | 30 (1.600) | 3 (0.080) | 20.0 |
| 17 | Type 2 diabetes | Weakness/fatigue | 8.9 | 184 (9.813) | 22 (0.587) | 16.7 |
| 18 | Type 2 diabetes | Hypokalaemia | 19.3 | 56 (2.987) | 7 (0.187) | 16.0 |
| 19 | Obesity | Weakness/fatigue | 11.7 | 150 (8.000) | 22 (0.587) | 13.6 |
| 20 | Hypertension | Osteoporosis | 15.6 | 95 (5.067) | 19 (0.507) | 10.0 |
| 21 | Type 2 diabetes | Premature menopause | 31.3 | 35 (1.867) | 7 (0187) | 10.0 |
| 22 | Osteoporosis | Serious infections | 15.1 | 66 (3.520) | 16 (0.427) | 8.3 |
| 23 | Hypertension | Serious infections | 4.6 | 269 (14.347) | 106 (2.827) | 5.1 |
| 24 | Psychiatric disorders | Serious infections | 4.5 | 245 (13.067) | 119 (3.173) | 4.1 |
The 24 pairs of conditions in this table where chosen as follows: authors initially selected for analysis 47 conditions defined by literature search and experts as being associated with CD in order to focus on conditions common enough in the CD population that their identification could be an aid to early diagnosis. After generating all possible two-way combinations of these conditions, authors chose for retention those that were either present at ≥5% frequency among patients with CD or present at ≥1% frequency if the RR of the condition was ≥15. Using this frequency and RR data along with expert consultation, authors narrowed the list down to 24 pairs of conditions. RR was calculated for these pairs and confirmed in the validation data set. These results indicate that patients with CD have a fourfold or higher risk of having any one of these 24 pairs of conditions compared with non-CD patients.
Table reprinted from Broder et al,11 with permission from the American Association of Clinical Endocrinologists.