Clinical characteristics, diagnosis, and treatment of Cushing’s syndrome: analysis of a multicenter registry in Antioquia, Colombia

Background: Cushing’s syndrome (CS) is a rare endocrine disorder caused by long-term exposure to excess cortisol and is linked to significant morbidity. Data from multiple centers in Latin America remains limited. Objectives: To describe the clinical, diagnostic, and treatment characteristics of patients with CS in a regional Colombian cohort and to assess surgical outcomes in patients with Cushing’s disease (CD) based on neurosurgical expertise. Design: Multicenter retrospective cohort study. Methods: Medical records from six hospitals in Antioquia, Colombia, were reviewed, including adult patients with biochemically confirmed endogenous CS diagnosed between 2010 and 2024. Data collected included sociodemographic, clinical features, diagnostic tests, etiological classification, treatments, and outcomes. In patients with CD, surgical remission, recurrence, persistence, and postoperative complications were compared based on neurosurgical expertise. Results: A total of 130 patients were included; 86.9% were women, with an average age of 50.7 years. The most common presenting features were weight gain (79.2%), moon face (36.9%), and striae (29.2%). CD was the leading cause (74.6%), followed by adrenal CS (17.6%) and ectopic adrenocorticotropic hormone syndrome (1.5%). The most frequently used diagnostic tests were 24-h urinary free cortisol and the 1-mg overnight dexamethasone suppression test, while late-night salivary cortisol and inferior petrosal sinus sampling were less commonly performed. Transsphenoidal surgery in CD achieved an initial remission rate of 63.3%, with no significant differences based on neurosurgical experience. All cases of adrenal CS underwent unilateral adrenalectomy. Conclusion: In this Colombian multicenter cohort, the clinical features, etiological distribution, and surgical outcomes in CS and CD were similar to those reported in specialized international centers. These findings highlight the importance of early detection, better access to diagnostic tools, and multidisciplinary care to improve outcomes in this rare disease.