Do patients with type 2 diabetes mellitus have an increased prevalence of Cushing’s syndrome?
Abstract
Many clinical features are common for patients with type 2 diabetes mellitus (T2DM) and Cushing's syndrome (CS) such as central obesity, hypertension and dyslipidaemia. Patients with CS often have T2DM. Because T2DM is much more frequent than CS, it is possible that some patients with T2DM have increased production of cortisol and thus represent patients with CS. The aim of this review was to evaluate the prevalence of CS in patients with T2DM. A search was performed in PubMed and Medline. We found seven prospective studies, two case-control studies and two cross-sectional studies. The difficulties in diagnosing subclinical CS is discussed. The most frequent tests for diagnosing CS, late-night salivary cortisol, 1-mg dexamethasone suppression test and urinary free cortisol are discussed and put in relation to the results of the literature found. The observed prevalence of CS in patients with T2DM varies widely between the different studies, ranging from 0-9.4%. This may be due to patient selection, differences in test methodology (including choice of test), cutoff values and different cortisol assays. The true prevalence of CS in T2DM has not been determined. We need more studies investigating the prevalence of CS in T2DM patients. There is a need for developing more specific tests for diagnosing CS in patients with only slightly elevated cortisol secretion and subclinical CS. We suggest that examination for hypercortisolism should only be performed in T2DM patients with a cushingoid appearance and hypertension or truncal obesity or dyslipidaemia.
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The frequency of Cushing syndrome in an unselected type 2 diabetes population was too low compared with false-positive results to make routine screening applicable, given high cost-effectiveness and lack of specific tests.
“On the other hand, the frequency of CS identified in an unselected population of type DM patients was too low compared with the number of false-positive results to make a routine screening strategy applicable in practice (), given its high cost-effectiveness and the lack of specific tests for diagnosing CS, especially in patients with a slightly elevated cortisol secretion and SCS ().”
From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [261]
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- Authors
- Krarup, T., Krarup, T., & Hagen, C.
- Affiliations
- Bispebjerg Hospital (DK)
- Corresponding author
- Krarup, Therese
- ORCID
- Krarup, Thure
- Venue
- Diabetes/Metabolism Research and Reviews
- Publisher
- Wiley
- Published
- 2012-03
- Volume
- 28
- Issue
- 3
- Pages
- 219-227
- ISSN
- 1520-7552 (ISSN-L)
- 1520-7560
- OpenAlex
- W1915288881
- Cited by
- 30
- References
- 58
- Citations by year
- 2025: 3 · 2022: 5 · 2019: 1 · 2018: 4 · 2017: 5 · 2016: 5 · 2015: 2 · 2014: 1 · 2013: 2 · 2012: 2
- FWCI
- 0.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes/Metabolism Research and Reviews (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Keywords
- Cushing's syndrome, type 2 diabetes, prevalence, hypercortisolism, subclinical Cushing's syndrome, cortisol measurement, late-night salivary cortisol, dexamethasone suppression test, urinary free cortisol, abdominal obesity, hypertension, dyslipidemia
- MeSH terms
- Cross-Sectional Studies, Cushing Syndrome, Dexamethasone, Diabetes Mellitus, Type 2, Humans, Hydrocortisone, Hypertension, Prospective Studies, United States, Prevalence, Case-Control Studies
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