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Cited by 65Pituitary Gland Disorders and TreatmentsAdrenal Hormones and DisordersAdrenal and Paraganglionic Tumors

Is there value in routine screening for Cushing’s syndrome in patients with diabetes?

Mullan, K., Black, N., Thiraviaraj, A., Bell, P. M., Burgess, C., Hunter, S. J., McCance, D. R., Leslie, H. +2 more·2010·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2009-2453
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Abstract

CONTEXT: Subclinical Cushing's syndrome has been described among diabetic populations in recent years, but no consensus has emerged about the value of screening. METHODS: We enrolled 201 consecutive patients attending our diabetes clinic and 79 controls. Patients with at least two of the following three criteria were offered screening using a 2300 h salivary cortisol test: glycosylated hemoglobin of at least 7%, body mass index of at least 25 kg/m(2), and a history of hypertension or blood pressure of at least 140/90 mm Hg. Results are expressed as mean +/- sem. RESULTS: Mean nighttime salivary cortisol levels were similar in the two groups (8.5 +/- 1.0 nmol/liter for diabetic patients vs. 5.8 +/- 1.0 nmol/liter for controls). Forty-seven patients (23%) had a value of at least 10 nmol/liter, which was set as a conservative threshold above which further investigation would be performed. Thirty-five (75%) agreed to further testing with a 1-mg overnight dexamethasone test. Of the remaining 12 patients, 10 were followed up clinically for at least 1 yr, and no evidence was found of the syndrome evolving. In 28 patients, serum cortisol suppressed to 60 nmol/liter or less. Of the seven patients who failed this test, four agreed to a 2 mg/d 48-h dexamethasone test, with serum cortisol suppressing to 60 nmol/liter or less in all four. Three declined this test but had normal 24-h urinary free cortisol levels. No patient had clinical features of hypercortisolism. CONCLUSIONS: The 1-3% detection rates of three recently published series have not been realized at our center where we studied a group using criteria making patients more likely to have hypercortisolism. Our results do not support the validity of screening patients without clinical features of Cushing's syndrome in the diabetes clinic.

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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 [254]

  • Two studies using midnight salivary cortisol did not detect subclinical hypercortisolism in more than 150 overweight or obese diabetic patients.

    “Similarly, by using MSaC, a poor test for screening SH, two studies did not detect SH in more than 150 overweight/obese diabetic patients (87,88).”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [87]

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Authors
Mullan, K., Black, N., Thiraviaraj, A., Bell, P. M., Burgess, C., Hunter, S. J., McCance, D. R., Leslie, H., Sheridan, B., & Atkinson, A. B.
Affiliations
Royal Victoria Hospital (GB)
Corresponding author
Atkinson, A. B.
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2010-05-01
Volume
95
Issue
5
Pages
2262-2265
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2009-2453
OpenAlex
W1980227882
Cited by
65
References
21
Citations by year
2025: 3 · 2024: 4 · 2023: 2 · 2022: 4 · 2021: 2 · 2020: 1 · 2019: 3 · 2018: 3 · 2017: 11 · 2016: 8 · 2015: 5 · 2014: 1 · 2013: 2 · 2012: 5
FWCI
4.34
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (Queen's University Belfast) (submittedVersion)
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, subclinical Cushing's syndrome, diabetes mellitus, screening, salivary cortisol, dexamethasone suppression test, hypercortisolism, diabetes clinic patients, detection rate
MeSH terms
Cushing Syndrome, Diagnostic Tests, Routine, Female, Glycated Hemoglobin, Humans, Hydrocortisone, Hypertension, Male, Mass Screening, Middle Aged, Saliva, Reproducibility of Results, Body Mass Index, Diabetes Complications

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