Cited by 182Pituitary Gland Disorders and TreatmentsAdrenal and Paraganglionic TumorsAdrenal Hormones and Disorders

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Pre‐clinical Cushing's syndrome: an unexpected frequent cause of poor glycaemic control in obese diabetic patients

Leibowitz, Gil, Tsur, Anat, Chayen, Susan D., Salameh, Mohammad, Raz, Itamar, Cerasi, Erol, Gross, David J.·1996·Clinical Endocrinology

DOI 10.1046/j.1365-2265.1996.737558.x

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Abstract

OBJECTIVE: Autonomous cortisol secretion without clinical stigmata of Cushing's syndrome (CS) has been recently recognized and termed pre-clinical or sub-clinical CS. The common assumption is that CS is an extremely rare cause of uncontrolled diabetes; however, the prevalence of this entity has not been studied. We assessed the prevalence of pre-clinical CS among obese patients with uncontrolled diabetes. PATIENTS AND DESIGN: (1) In a retrospective analysis, the medical records of 63 patients with endogenous CS were reviewed. (2) In a cross-sectional study, 90 obese patients (BMI > 25 kg/m2) followed in a University Hospital and the local Health Fund endocrine and diabetes clinics, with poorly controlled diabetes (glycosylated haemoglobin > 9%), underwent an overnight 1 mg dexamethasone suppression. In patients with non-suppressible cortisol levels (> 140 nmol/l), Liddle's 2 and 8 mg dexamethasone suppression tests and imaging studies were performed. MEASUREMENTS: The prevalence of poorly controlled diabetes, the major presenting symptom of CS, was assessed in the retrospective analysis. The prevalence of "true' CS and the false positive rate in the overnight dexamethasone suppression test were calculated. The endocrine evaluation of the patients with pre-clinical CS and the effects of surgical cure on glycaemic control are described. RESULTS: In the retrospective analysis, 11 (17.5%) had diabetes and 2 (3.2%) lacked the classic physical characteristics of the syndrome. In the cross-sectional study, 4 patients failed to suppress plasma cortisol (< 140 nmol/l). In one patient the diagnosis of CS was not confirmed by a standard Liddle's test and was therefore considered false positive. In the other 3, the diagnosis of CS was confirmed (prevalence of 3.3%, 95% confidence interval 1-9%). In all other patients the overnight cortisol suppression test was normal (cortisol level 47.3 +/- 2.5 nmol/l (mean +/- SEM)). After surgical treatment of CS, glycaemic control was markedly improved in all 5 patients (2 from retrospective and 3 from cross-sectional studies). CONCLUSIONS: The prevalence of pre-clinical Cushing's syndrome in obese patients with poorly controlled diabetes appears to be considerably higher than previously believed. The overnight dexamethasone suppression test proved to be a simple, sensitive and highly specific screening test for Cushing's syndrome despite the presence of obesity and hyperglycaemia.

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BackgroundResult

Authors: Leibowitz, G., Tsur, A., Chayen, S. D., Salameh, M., Raz, I., Cerasi, E., & Gross, D. J.
Affiliations: Hebrew University of Jerusalem (IL)
Corresponding author: Gross, David J.
ORCID: Leibowitz, Gil
Tsur, Anat
Raz, Itamar
Cerasi, Erol
Venue: Clinical Endocrinology
Publisher: Wiley
Published: 1996-06
Volume: 44
Issue: 6
Pages: 717-722
ISSN: 0300-0664 (ISSN-L)
1365-2265
DOI: 10.1046/j.1365-2265.1996.737558.x
OpenAlex: W2019770879
Cited by: 180
References: 0
Citations by year: 2026: 1 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 5 · 2020: 3 · 2019: 4 · 2018: 3 · 2017: 6 · 2016: 7 · 2015: 12 · 2014: 5 · 2013: 4 · 2012: 12
FWCI: 1.34
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor, 2706 d)
Locations: Clinical Endocrinology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords: syndromes, uncontrolled diabetes, obesity, glycemic control, dexamethasone suppression test, prevalence, false positive rate, adrenalectomy, surgical treatment, screening test, glycosylated haemoglobin, hypercortisolism, adrenal incidentaloma
MeSH terms: Adult, Aged, Cross-Sectional Studies, Cushing Syndrome, Dexamethasone, Diabetes Mellitus, Female, Humans, Hydrocortisone, Male, Middle Aged, Obesity, Retrospective Studies, Prevalence

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Pre‐clinical Cushing's syndrome: an unexpected frequent cause of poor glycaemic control in obese diabetic patients

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