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Occult Cushing’s Syndrome in Type-2 Diabetes
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 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 the citing paper
“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 the citing paper
“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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Metadata
- 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)
- 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
- 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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