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Association of subclinical hypercortisolism with type 2 diabetes mellitus: a case-control study in hospitalized patients
Abstract
OBJECTIVE: Subclinical hypercortisolism (SH) may play a role in several metabolic disorders, including diabetes. No data are available on the relative prevalence of SH in type 2 diabetes (T2D). In order to compare the prevalence of SH in T2D and matched non-diabetic control individuals, we performed a case-controlled, multicenter, 12-month study, enrolling 294 consecutive T2D inpatients (1.7% dropped out the study) with no evidence of clinical hypercortisolism and 189 consecutive age- and body mass index-matched non-diabetic inpatients (none of whom dropped out). DESIGN AND METHODS: Ascertained SH (ASH) was diagnosed in individuals (i) with plasma cortisol after 1 mg overnight dexamethasone suppression >1.8 microg/dl (50 nmol/l), (ii) with more than one of the following: (a) urinary free cortisol >60.0 microg/24 h (165.6 nmol/24 h), (b) plasma ACTH <10.0 pg/ml (2.2 pmol/l) or (c) plasma cortisol >7.5 microg/dl (207 nmol/l) at 24:00 h or >1.4 microg/dl (38.6 nmol/l) after dexamethasone-CRH (serum cortisol after corticotrophin-releasing hormone stimulus during dexamethasone administration) test, and (iii) in whom the source of glucocorticoid excess was suggested by imaging and by additional biochemical tests (for ACTH-dependent ASH). RESULTS: Prevalence of ASH was higher in diabetic individuals than in controls (9.4 versus 2.1%; adjusted odds ratio, 4.8; 95% confidence interval, 1.6-14.1; P = 0.004). In our population the proportion of T2D which is statistically attributable to ASH was approx. 7%. Among diabetic patients, the presence of severe diabetes (as defined by the coexistence of hypertension, dyslipidaemia and insulin treatment) was significantly associated with SH (adjusted odds ratio, 3.8; 95% confidence interval, 1.4-10.2; P = 0.017). CONCLUSIONS: In hospitalized patients, SH is associated with T2D.
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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 [247]
In the citing paper
“These data were confirmed in a similar controlled study on 294 diabetic inpatients in whom a 10.8% prevalence of SH was found, with pituitary, adrenal, and undefined/ectopic origin accounting for 1.4, 7.2, and 2.2%, respectively (83).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [83]
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Metadata
- Authors
- Chiodini, I., Torlontano, M., Scillitani, A., Arosio, M., Bacci, S., Di Lembo, S., Epaminonda, P., Augello, G., Enrini, R., Ambrosi, B., Adda, G., & Trischitta, V.
- Affiliations
- Casa Sollievo della Sofferenza (IT)
- University of Milan (IT)
- Corresponding author
- Chiodini, Iacopo
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2005-12
- Volume
- 153
- Issue
- 6
- Pages
- 837-844
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W2171330156
- Cited by
- 190
- References
- 23
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 6 · 2023: 8 · 2022: 6 · 2021: 14 · 2020: 8 · 2019: 4 · 2018: 6 · 2017: 10 · 2016: 13 · 2015: 13 · 2014: 8 · 2013: 6 · 2012: 15
- FWCI
- 5.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Keywords
- subclinical hypercortisolism, type 2 diabetes, prevalence, ACTH-dependent Cushing's syndrome, ACTH-independent Cushing's syndrome, dexamethasone suppression test, urinary free cortisol, hospitalized patients, severe diabetes, hypertension, dyslipidemia, insulin therapy, glucocorticoid excess, attributable fraction, metabolic disorders, ACTH, cortisol, Cushing's disease
- MeSH terms
- Adrenocorticotropic Hormone, Adult, Aged, Aged, 80 and over, Corticotropin-Releasing Hormone, Cushing Syndrome, Dexamethasone, Diabetes Mellitus, Type 2, Female, Humans, Hydrocortisone, Male, Middle Aged, Body Mass Index, Case-Control Studies
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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