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Cited by 288Pituitary Gland Disorders and TreatmentsAdrenal and Paraganglionic TumorsAdrenal Hormones and Disorders

Occult Cushing’s syndrome in type-2 diabetes

Catargi, Bogdan, Rigalleau, Vincent, Poussin, Agathe, Ronci-Chaix, Nathalie, Bex, Veronique, Vergnot, Vincent, Gin, Henri, Roger, Patrick +1 more·2003·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2003-030254
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Abstract

Subclinical Cushing's syndrome (SCS) caused by adrenal incidentalomas is frequently associated with overweight and insulin resistance. Metabolic syndrome X may therefore be a clue to the presence of CS. However, the incidence of CS in this situation remains unknown. We have conducted a prospective study to evaluate the prevalence of occult CS in overweight, type-2 diabetic patients devoided of specific clinical symptoms of CS. Two hundred overweight, type-2 diabetic patients, consecutively referred for poor metabolic control (HbA(1C) > 8%), were studied as inpatients. A first screening step was performed with the 1-mg overnight dexamethasone suppression test (DST) using a revised criterion for cortisol suppression (60 nmol/liter) to maximize the sensitivity of the procedure. A second confirmatory step of biochemical investigations (midnight plasma cortisol concentration, plasma cortisol circadian rhythm, morning plasma ACTH concentration, 24-h urinary free cortisol, and 4-mg i.v. DST) was performed in patients with impaired 1-mg DST. A third step of imaging studies was performed according to the results of second-step investigations. Fifty-two patients had impaired 1-mg DST. Among these, 47 were further evaluated. Thirty were considered as false positives of the 1-mg DST, whereas 17 displayed at least one additional biological abnormality of the hypothalamic-pituitary-adrenal axis. Definitive occult CS was identified in four patients (2% of the whole series) with Cushing's disease (n = 3) and surgically proven adrenal adenoma (n = 1). Definitive diagnosis remains to be established in seven additional patients (3.5%) with mild occult CS associated with unsuppressed plasma ACTH concentrations and a unilateral adrenal tumor of 10-29 mm in size showing prevalent uptake at radiocholesterol scintigraphy. In conclusion, a relatively high prevalence of occult CS was found in our study. Further studies are needed to evaluate the impact of the cure of occult CS on obesity and diabetes mellitus in these patients. Such studies might provide a rationale for systematic screening of occult CS in this population.

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  • The prevalence of previously unsuspected Cushing syndrome in patients with type 2 diabetes ranges from 0% to 9.4%.

    “The association between DM and CS has been examined in various studies, which have shown a prevalence of previously unsuspected CS in patients with type  DM ranging from % to .% (Table ) (-).”

    From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [246]

  • In that study, overall prevalence of subclinical hypercortisolism could be estimated at almost 5.5%, with pituitary and adrenal origin at 1.5% and 4.0%, respectively.

    “Overall in this study, the prevalence of SH could be estimated to be almost 5.5%, with a pituitary and adrenal origin of 1.5 and 4.0%, respectively.”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [82]

  • In a larger study of 200 diabetic patients using a lower 1-mg dexamethasone suppression test cutoff, subclinical hypercortisolism was found in four patients (2.0% prevalence), with three pituitary and one adrenal origin.

    “In a larger study of a similar population using 1-mg DST as a screening test with a lower and, therefore, more sensitive cutoff, SH was ascertained in four (three of pituitary and one of adrenal origin) of 200 diabetic patients studied (2.0% prevalence) (82).”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [82]

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Authors
Catargi, B., Rigalleau, V., Poussin, A., Ronci-Chaix, N., Bex, V., Vergnot, V., Gin, H., Roger, P., & Tabarin, A.
Affiliations
  • Departments of Endocrinology (B.C., A.P., V.B., N.R.-C., P.R., A.T.), 33604 Pessac, France
  • Centre Hospitalier Universitaire de Bordeaux (FR)
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2003-12-01
Volume
88
Issue
12
Pages
5808-5813
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2003-030254
OpenAlex
W2054473324
Cited by
287
References
46
Citations by year
2026: 4 · 2025: 8 · 2024: 4 · 2023: 2 · 2022: 7 · 2021: 8 · 2020: 10 · 2019: 5 · 2018: 7 · 2017: 15 · 2016: 17 · 2015: 17 · 2014: 16 · 2013: 12 · 2012: 15
FWCI
5.69
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (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
subclinical Cushing's syndrome, type 2 diabetes, overweight, adrenal incidentaloma, Cushing's disease, adrenal adenoma, dexamethasone suppression test, hypothalamic-pituitary-adrenal axis, ACTH, plasma cortisol, urinary free cortisol, metabolic syndrome X, screening, prevalence
MeSH terms
Aged, Cushing Syndrome, Dexamethasone, Diabetes Mellitus, Type 2, Female, France, Glucocorticoids, Humans, Hydrocortisone, Male, Mass Screening, Middle Aged, Obesity, Prospective Studies, Sensitivity and Specificity, Cohort Studies, Prevalence

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