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Massimo Terzolo, Giuseppe Reimondo, Iacopo Chiodini, Roberto Castello, Roberta Giordano, Enrica Ciccarelli, Paolo Limone, Claudio Crivellaro, Irma Martinelli, Marcella Montini, Olga Disoteo, Bruno Ambrosi, Roberto Lanzi, Maura Arosio, Sanzio Senni, Antonio Balestrieri, Erica Solaroli, Bruno Madeo, Raffaella De Giovanni, Felice Strollo, Rodolfo Battista, Alessandro Scorsone, Vito A. Giagulli, Daniela Collura, Aldo Scillitani, Renato Cozzi, Marco Faustini-Fustini, Anna Pia, Roberta Rinaldi, Barbara Allasino, Giulia Peraga, Francesco Tassone, Piernicola Garofalo, Enrico Papini, Giorgio Borretta, Screening of Cushing's Syndrome in Outpatients with Type 2 Diabetes: Results of a Prospective Multicentric Study in Italy, The Journal of Clinical Endocrinology & Metabolism, Volume 97, Issue 10, 1 October 2012, Pages 3467–3475, https://doi.org/10.1210/jc.2012-1323
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Abstract
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.
Our aim was to evaluate the prevalence of unsuspected Cushing's syndrome among outpatients with type 2 diabetes.
This was a cross-sectional prospective study in 24 diabetes clinics across Italy.
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.
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.
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.
