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Vol. 17. Issue 6.
Pages 313-317 (June - July 2021)
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Vol. 17. Issue 6.
Pages 313-317 (June - July 2021)
Original Article
DOI: 10.1016/j.reumae.2019.10.008
Validity of the Cushing’s syndrome severity index in patients with iatrogenic Cushing’s syndrome
Validación del índice de gravedad del síndrome de Cushing en pacientes con síndrome de Cushing iatrógénico
Everardo Álvarez-Hernández
Corresponding author

Corresponding author.
, Graciela Mercado-Molina, Rosa Consuelo Barrera-Guerra
Servicio de Reumatología, Hospital General Dr. Eduardo Liceaga, Mexico City, Mexico
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Figures (2)
Tables (4)
Table 1. Consistency of the Cushing’s syndrome severity index.
Table 2. Interobserver variability of the CSI.
Table 3. CSI scores based on glucocorticoid dose used.
Table 4. Correlation of the CSI with variables related to the use of glucocorticoids and the presence of adverse effects.
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Additional material (1)

Currently there are no clinimetric instruments for the measurement of the severity of iatrogenic Cushing's syndrome (ICS). Sonino et al. created a clinical severity index of endogenous Cushing’s disease (CSI) but it has not been applied to patients with ICS.


To validate and determine the utility of the CSI and its correlation with clinical variables in rheumatological patients with continuous use of glucocorticoids (GC).

Subjects and methods

patients with a history of continuous systemic GC use (for at least 4 weeks) indicated for treatment of rheumatological disease were included. All the patients filled out a questionnaire on sociodemographic data, characteristics of the CG used; the way of use and the presence or absence of adverse events. The CSI was applied by 2 observers independently. Consistency, interobserver concordance and principal component analysis were calculated.


32 patients with an average age of 35.72 ± 12.8 years were studied; 29 were women (90.6%). The average CSI score by the first observer was 3.50 ± 2.02, and by the second observer was 2.31 ± 1.75 (P = .004). The interobserver concordance was low in the items with imprecise definitions; for which modifications were made in the definitions to improve their performance. The CSI scores correlated with the presence of adverse effects and the type of dose used.


The CSI has an adequate correlation with clinical manifestations in patients with chronic use of GC. The clinimetric characteristics of the questionnaire improved by standardising the definitions of subjective clinical variables.

Iatrogenic Cushing’s syndrome
Severity index

Actualmente no se cuenta con instrumentos clinimétricos para la medición de la gravedad del síndrome de Cushing iatrógeno (SCI). Sonino y cols crearon un índice clínico de gravedad de Cushing endógeno (IGC) pero no ha sido aplicado a pacientes con SCI.


Validar y determinar la utilidad del IGC y su correlación con variables clínicas en pacientes reumatológicos con uso de glucocorticoides (GC) de forma continua.

Sujetos y métodos

Se incluyó a pacientes con antecedentes de uso de GC sistémicos de forma continua indicados para el tratamiento de la enfermedad reumatológica, por lo menos durante 4 semanas. Todos los pacientes llenaron un cuestionario sobre datos sociodemográficos, características de los GC empleados; la forma de uso y la presencia o ausencia de eventos adversos. Se aplicó el IGC por 2 observadores de forma independiente. Se calculó la consistencia, la concordancia interobservador y un análisis de componentes principales.


Se estudió a 32 pacientes con edad promedio de 35,72 ± 12,8 años; 29 eran mujeres (90,6%). La calificación promedio del IGC por el primer observador fue de 3,50 ± 2,02, y del segundo observador fue de 2,31 ± 1,75 (p = 0,004). La concordancia interobservador fue baja en los ítems con definiciones imprecisas, por lo cual se hicieron modificaciones en las definiciones para mejorar su desempeño. Los puntajes del IGC correlacionaron con la presencia de efectos adversos y el tipo de dosis utilizada.


El IGC tiene una adecuada correlación con manifestaciones clínicas en pacientes con uso crónico de GC. Las características clinimétricas del cuestionario mejoraron al estandarizar las definiciones de variables clínicas subjetivas.

Palabras clave:
Síndrome de Cushing iatrógeno
Índice de gravedad


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