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Cited by 19Pituitary Gland Disorders and TreatmentsAdrenal Hormones and DisordersAdrenal and Paraganglionic Tumors

Is it worthwhile to screen patients with type 2 diabetes mellitus for subclinical Cushing’s syndrome?

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Budyal, Sweta, Jadhav, Swati Sachin, Kasaliwal, Rajeev, Patt, Hiren, Khare, Shruti, Shivane, Vyankatesh, Lila, Anurag R, Bandgar, Tushar +1 more·2015·Endocrine Connections
DOI 10.1530/ec-15-0078PMC PMC4621608
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Abstract

Variable prevalence of subclinical Cushing's syndrome (SCS) has been reported in patients with type 2 diabetes mellitus (T2DM), making the need for screening in this population uncertain. It is unknown if this variability is solely due to study-related methodological differences or a reflection of true differences in ethnic predisposition. The objective of this study is to explore the prevalence of SCS in Asian Indian patients with T2DM. In this prospective single center study conducted in a tertiary care referral center, 993 T2DM outpatients without any discriminatory clinical features (easy bruising, facial plethora, proximal muscle weakness, and/or striae) of hypercortisolism underwent an overnight 1 mg dexamethasone suppression test (ODST). ODST serum cortisol ≥1.8 μg/dl was considered positive, and those with positive results were subjected to 48 h, 2 mg/day low dose DST (LDDST). A stepwise evaluation for endogenous hypercortisolism was planned for patients with LDDST serum cortisol ≥1.8 μg/dl. Patients with positive ODST and negative LDDST were followed up clinically and re-evaluated a year later for the development of clinically evident Cushing's syndrome (CS). In this largest single center study reported to date, we found 37 out of 993 (3.72%) patients had ODST serum cortisol ≥1.8 μg/dl. None of them had LDDST cortisol ≥1.8 μg/dl, nor did they develop clinically evident CS over a follow-up period of 1 year. Specificity of ODST for screening of CS was 96.3% in our cohort. None of the T2DM outpatients in our cohort had SCS, hence cautioning against routine biochemical screening for SCS in this cohort. We suggest screening be based on clinical suspicion only.

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  • No cases of confirmed subclinical Cushing syndrome emerged among 933 diabetic outpatients in India; patients with clinical signs suggestive of hypercortisolism were excluded a priori.

    “It is worth noting that no cases of confirmed SCS emerged among a population of  diabetic outpatients forming another large series in a recent study in India (); in this study, however, patients with clinical signs suggestive of hypercortisolism (easy bruising, facial plethora, proximal muscle weakness, and/or striae) were excluded a priori from the evaluation.”

    From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [259]

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Authors
Budyal, S., Jadhav, S. S., Kasaliwal, R., Patt, H., Khare, S., Shivane, V., Lila, A. R., Bandgar, T., & Shah, N. S.
Affiliations
King Edward Memorial Hospital and Seth G.S. Medical College (IN)
Corresponding author
Lila, Anurag R
ORCID
Venue
Endocrine Connections
Publisher
Bioscientifica
Published
2015-12
Volume
4
Issue
4
Pages
242-248
ISSN
2049-3614 (ISSN-L)
DOI
10.1530/ec-15-0078
PMC
PMC4621608
OpenAlex
W2198992753
Cited by
19
References
24
Citations by year
2025: 2 · 2024: 3 · 2022: 1 · 2021: 3 · 2020: 1 · 2019: 1 · 2018: 2 · 2017: 4 · 2016: 2
FWCI
2.32
Type
journal article
Language
en
Open access
Licence
Locations
  • Endocrine Connections (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
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
subclinical Cushing's syndrome, type 2 diabetes, screening, dexamethasone suppression test, low-dose dexamethasone suppression test, endogenous hypercortisolism, Indian patients, prevalence, diagnostic specificity, clinical suspicion

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