Referral to definitive surgical treatment in Cushing's syndrome - an odyssey that requires attention
Mathara, Shani Aylwin, Simon Mamoojee, Yasir Flanagan, Daniel Pal, Aparna Gleeson, Helena
Mathara, Shani
Aylwin, Simon
Mamoojee, Yasir
Flanagan, Daniel
Pal, Aparna
Gleeson, Helena
Abstract
OBJECTIVE: Cushing's syndrome (CS) requires prompt recognition and referral to explore definitive intervention. Delays can lead to increased mortality and death. This service evaluation aimed to distinguish time from initial referral to definitive surgical management in CS.
CONTEXT: Clinical standards for appropriate timelines for referral are undefined.
DESIGN: A retrospective service evaluation across five specialised endocrine surgical centres reviewing the timeline from initial referral to definitive surgical treatment.
PATIENTS: All adult patients diagnosed with CS who underwent definitive surgery between January 2018 and December 2019.
MEASUREMENTS: Data were collected on initial referrer, time to first clinical review, tests performed within non-surgical endocrinology centres, timing of referral to specialised endocrine surgical centre, clinical review (if applicable), multi-disciplinary meeting and definitive surgery.
RESULTS: 71 patients received definitive surgical treatment for CS (37 pituitary CS and 34 adrenal CS). Median time from initial primary care referral to a specialised endocrine surgical centre was quicker if referred directly (56 days) than if initially referred to a non-surgical endocrinology hospital (159 days). The overall median time from all initial referrals to definitive surgical treatment was 211 days for pituitary CS and 253 days for adrenal CS. Patients referred directly to the specialised endocrine surgical centre had surgery in a median of 196 days (187 days and 252 days for pituitary and adrenal CS respectively) compared with 253 days in patients that were referred via a non-surgical endocrinology centre (249 days and 346 days for pituitary and adrenal CS respectively).
CONCLUSION: There were delays from initial referral to definitive surgical treatment of CS. Clearer, clinically focussed pathways and (inter)national standards on early management of Cushing's syndrome should be considered to more address unwarranted delays in treating Cushing's syndrome.
MIDER Authors
Affiliations
University of Birmingham; University Hospitals Birmingham NHS Foundation Trust; South Warwickshire University NHS Foundation Trust; Oxford University Hospitals NHS Foundation Trust; Kings College Hospital NHS Foundation Trust; The Newcastle upon Tyne Hospitals NHS Foundation Trust; University Hospitals Plymouth NHS Trust
Date
2026-07-10
Type
Article
Citation
Coulden A, Arshad A, Mathara S, Aylwin S, Mamoojee Y, Flanagan D, Pal A, Gittoes N, Gleeson H. Referral to Definitive Surgical Treatment in Cushing's Syndrome - An Odyssey That Requires Attention. Clin Endocrinol (Oxf). 2026 Jul 10. doi: 10.1111/cen.70175. Epub ahead of print.