Screening of Cushing’s syndrome in outpatients with type 2 diabetes: results of a prospective multicentric study in Italy
Open accessAbstract
CONTEXT: Cushing's syndrome may remain unrecognized among patients referred for metabolic syndrome; thus, a proactive screening has been suggested in certain patient populations with features of the disorder. However, conflicting data have been reported on the prevalence of Cushing's syndrome in patients with type 2 diabetes. OBJECTIVE: Our aim was to evaluate the prevalence of unsuspected Cushing's syndrome among outpatients with type 2 diabetes. DESIGN AND SETTING: This was a cross-sectional prospective study in 24 diabetes clinics across Italy. PATIENTS: Between June 2006 and April 2008, 813 patients with known type 2 diabetes without clinically overt hypercortisolism were evaluated. Follow-up of the study was closed in September 2010. Patients were not selected for characteristics conferring a higher pretest probability of hypercortisolism. Patients underwent a first screening step with the 1-mg overnight dexamethasone suppression test. RESULTS: Forty patients failed to suppress serum cortisol less than 5.0 μg/dl (138 nmol/liter) and underwent a standard 2-d, 2-mg dexamethasone suppression test, after which six patients (0.6% of the overall series) failed to suppress cortisol less than 1.8 μg/dl (50 nmol/liter), receiving a definitive diagnosis of Cushing's syndrome that was adrenal dependent in five patients. Four patients were cured, being able to discontinue, or reduce, the glucose-lowering agents. CONCLUSIONS: The present data do not support widespread screening of patients with type 2 diabetes for Cushing's syndrome; however, the disorder is less rare than previously thought when considering epidemiology of type 2 diabetes. Our results support a case-finding approach in patients with uncontrolled diabetes and hypertension despite appropriate treatment.
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In one of the largest series, 0.7% of 813 unselected patients with type 2 diabetes had previously unsuspected Cushing syndrome.
“In one of the largest series reported to date (), a frequency of .% of previously unsuspected CS was identified in a cohort of unselected patients with type DM.”
From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [257]
The frequency of Cushing syndrome was 5.1% among patients with HbA1c above 9.0% despite intensive treatment and with blood pressure not on target despite three drugs.
“In addition, the frequency of CS was .% among patients with HbAc levels ..% despite intensive treatment and with blood pressure levels not on target despite the use of three drugs ().”
From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [257]
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- Authors
- Terzolo, M., Reimondo, G., Chiodini, I., Castello, R., Giordano, R., Ciccarelli, E., Limone, P., Crivellaro, C., Martinelli, I., Montini, M., Disoteo, O., Ambrosi, B., Lanzi, R., Arosio, M., Senni, S., Balestrieri, A., Solaroli, E., Madeo, B., De Giovanni, R., Strollo, F., Battista, R., Scorsone, A., Giagulli, V. A., Collura, D., Scillitani, A., Cozzi, R., Faustini-Fustini, M., Pia, A., Rinaldi, R., Allasino, B., Peraga, G., Tassone, F., Garofalo, P., Papini, E., & Borretta, G.
- Affiliations
- Ospedale San Luigi Gonzaga (IT)
- University of Turin (IT)
- Azienda Ospedaliera Universitaria Integrata Verona (IT)
- A. O. Ordine Mauriziano di Torino (IT)
- Ospedale di Bolzano (IT)
- Azienda Ospedaliera Sant’Antonio Abate di Gallarate (IT)
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- University of Milan (IT)
- Ospedale Bellaria (IT)
- Istituti di Ricovero e Cura a Carattere Scientifico (IT)
- Casa Sollievo della Sofferenza (IT)
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT)
- Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo (IT)
- Ospedale Regina Apostolorum (IT)
- Ospedale Vincenzo Cervello (IT)
- Corresponding author
- Terzolo, Massimo
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2012-10
- Volume
- 97
- Issue
- 10
- Pages
- 3467-3475
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2087385258
- Cited by
- 89
- References
- 38
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 6 · 2023: 3 · 2022: 7 · 2021: 6 · 2020: 7 · 2019: 4 · 2018: 4 · 2017: 7 · 2016: 12 · 2015: 13 · 2014: 12 · 2013: 5
- FWCI
- 7.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
- 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, hypercortisolism, screening, dexamethasone suppression test, prevalence, case finding, uncontrolled diabetes, hypertension
- MeSH terms
- Adult, Aged, Cross-Sectional Studies, Cushing Syndrome, Diabetes Mellitus, Type 2, Female, Humans, Hypertension, Italy, Male, Mass Screening, Middle Aged, Outpatients, Prospective Studies, Risk Factors, Prevalence
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