Time to Diagnosis in Cushing’s Syndrome: A Meta-Analysis Based on 5367 Patients


Signs and symptoms of Cushing’s syndrome (CS) overlap with common diseases, such as the metabolic syndrome, obesity, osteoporosis, and depression. Therefore, it can take years to finally diagnose CS, although early diagnosis is important for prevention of complications.


The aim of this study was to assess the time span between first symptoms and diagnosis of CS in different populations to identify factors associated with an early diagnosis.

Data Sources

A systematic literature search via PubMed was performed to identify studies reporting on time to diagnosis in CS. In addition, unpublished data from patients of our tertiary care center and 4 other centers were included.

Study Selection

Clinical studies reporting on the time to diagnosis of CS were eligible. Corresponding authors were contacted to obtain additional information relevant to the research question.

Data Extraction

Data were extracted from the text of the retrieved articles and from additional information provided by authors contacted successfully. From initially 3326 screened studies 44 were included.

Data Synthesis

Mean time to diagnosis for patients with CS was 34 months (ectopic CS: 14 months; adrenal CS: 30 months; and pituitary CS: 38 months; P < .001). No difference was found for gender, age (<18 and ≥18 years), and year of diagnosis (before and after 2000). Patients with pituitary CS had a longer time to diagnosis in Germany than elsewhere.


Time to diagnosis differs for subtypes of CS but not for gender and age. Time to diagnosis remains to be long and requires to be improved.

Overview publication

TitleTime to Diagnosis in Cushing’s Syndrome: A Meta-Analysis Based on 5367 Patients
DateOctober 29th, 2019
Issue nameThe Journal of Clinical Endocrinology & Metabolism
Issue numberVolume 105, Issue 3, March 2020, Pages e12–e22
AuthorsGerman Rubinstein, Andrea Osswald, Eva Hoster, Marco Losa, Atanaska Elenkova, Sabina Zacharieva, Márcio Carlos Machado, Felicia Alexandra Hanzu, Stephanie Zopp, Katrin Ritzel, Anna Riester, Leah Theresa Braun, Ilonka Kreitschmann-Andermahr, Helen L Storr, Prachi Bansal, María-José Barahona, Elisa Cosaro, Sema Ciftci Dogansen, Philip C Johnston, Ricardo Santos de Oliveira, Christian Raftopoulos, Carla Scaroni, Elena Valassi, Steven J A van der Werff, Jochen Schopohl, Felix Beuschlein & Martin Reincke
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