Increased diagnostic probability of subclinical Cushing’s syndrome in a population sample of overweight adult patients with type 2 diabetes mellitus
Open accessAbstract
Endogenous Cushing's Syndrome (CS) is unusual. Patients with subclinical CS (SCS) present altered cortisol dynamics without obvious manifestations. CS occurs in 2-3% of obese poorly controlled diabetics. We studied 103 overweight adult outpatients with type 2 diabetes to examine for cortisol abnormalities and SCS. All collected salivary cortisol at 23:00 h and salivary and serum cortisol after a 1 mg dexamethasone suppression test (DST). Patients whose results were in the upper quintile for each test (253 ng/dL, 47 ng/dL, and 1.8 microg/dL, respectively for the 23:00 h and post-DST saliva and serum cortisol) were re-investigated. Average values from the upper quintile group were 2.5-fold higher than in the remaining patients. After a confirmatory 2 mg x 2 day DST the investigation for CS was ended for 61 patients with all normal tests and 33 with only one (false) positive test. All 8 patients who had two abnormal tests had subsequent normal 24h-urinary cortisol, and 3 of them were likely to have SCS (abnormal cortisol tests and positive imaging). However, a final diagnosis could not to be confirmed by surgery or pathology. Although not confirmatory, the results of this study suggest that the prevalence of SCS is considerably higher in populations at risk than in the general population.
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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 [249]
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- Authors
- Caetano, M. S. S., Silva, R. D. C., & Kater, C. E.
- Affiliations
- Universidade Federal de São Paulo (BR)
- ORCID
- Kater, Claudio E.
- Venue
- Arquivos Brasileiros de Endocrinologia & Metabologia
- Publisher
- FapUNIFESP (SciELO)
- Published
- 2007-10
- Volume
- 51
- Issue
- 7
- Pages
- 1118-1127
- ISSN
- 0004-2730 (ISSN-L)
- OpenAlex
- W1986148945
- Cited by
- 36
- References
- 43
- Citations by year
- 2024: 2 · 2022: 1 · 2021: 4 · 2020: 1 · 2018: 1 · 2017: 4 · 2016: 4 · 2015: 2 · 2014: 2 · 2012: 3
- FWCI
- 2.20
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc
- Locations
- Arquivos Brasileiros de Endocrinologia & Metabologia (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, other-oa)
- Americanae (AECID Library) (submittedVersion, other-oa)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (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
- subclinical Cushing's syndrome, endogenous Cushing's syndrome, type 2 diabetes, overweight, dexamethasone suppression test, salivary cortisol, prevalence
- MeSH terms
- Adult, Aged, Aged, 80 and over, Algorithms, Circadian Rhythm, Cushing Syndrome, Dexamethasone, Diabetes Mellitus, Type 2, Female, Glucocorticoids, Humans, Hydrocortisone, Male, Middle Aged, Obesity, Saliva, Statistics, Nonparametric
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