Skip to main content

Advertisement

SpringerLink
Log in

Cushing’s syndrome in type 2 diabetes patients with poor glycemic control

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Cushing’s syndrome may be more frequent in some specific patient groups such as type 2 diabetes and obesity. The aim of this study was to investigate the prevalence of Cushing’s syndrome in outpatients with type 2 diabetes with poor glycemic control despite at least 3-months insulin therapy. Outpatients with type 2 diabetes whose glycemic control is poor (Hb Alc value >7 %) despite receiving at least 3-months long insulin treatment (insulin alone or insulin with oral antidiabetics) were included. Patients with classic features of Cushing’s syndrome were excluded. Overnight 1 mg dexamethasone suppression test (DST) was performed as a screening test. A total of 277 patients with type 2 diabetes whose glycemic control is poor (Hb Alc value >7 %) despite insulin therapy were included. Two of the 277 patients with type 2 diabetes were diagnosed with Cushing’s syndrome (0.72 %). Hypertension was statistically more frequent in the patients with cortisol levels ≥1.8 μg/dL than the patients with cortisol levels <1.8 μg/dL after overnight 1 mg DST (p = 0.041). Statistically significant correlation was determined between cortisol levels after 1 mg DST and age, daily insulin dose (r = 0.266 and p < 0.001, r = 0.163 and p = 0.008, respectively). According to our findings, the prevalence of Cushing’s syndrome among patients with type 2 diabetes with poor glycemic control despite insulin therapy is much higher than in the general population. The patients with type 2 diabetes with poor glycemic control despite at least three months of insulin therapy should be additionally tested for Cushing’s syndrome if they have high dose insülin requirements.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. J. Newell-Price, X. Bertagna, A.B. Grossman, L.K. Nieman, Cushing’s syndrome. Lancet 367, 1605–1617 (2006)

    Article  CAS  PubMed  Google Scholar 

  2. C. Steffensen, A.S. Bak, K.Z. Rubeck, J.O.L. Jorgensen, Epidemiology of Cushing’s syndrome. Neuroendocrinology 92(suppl. 1), 1–5 (2010)

    Article  CAS  PubMed  Google Scholar 

  3. B. Catargi, V. Rigalleau, A. Poussin, N. Ronci-Chaix, V. Bex, V. Vergnot, H. Gin, P. Roger, A. Tabarin, Occult Cushing’s syndrome in type-2 diabetes. J. Clin. Endocrinol. Metab. 88, 5808–5813 (2003)

    Article  CAS  PubMed  Google Scholar 

  4. G. Leibowitz, A. Tsur, S.D. Chayen, M. Salameh, I. Raz, E. Cerasi, D.J. Gross, Pre-clinical Cushing’s syndrome: an unexpected frequent cause of poor glycaemic control in obese diabetic patients. Clin Endocrinol (Oxf) 44(6), 717–722 (1996)

    Article  CAS  Google Scholar 

  5. I. Chiodini, M. Torlontano, A. Scillitani, M. Arosio, S. Bacci, S. Di Lembo, P. Epaminonda, G. Augello, R. Enrini, B. Ambrosi, G. Adda, V. Trischitta, Association of subclinical hypercortisolism with type 2 diabetes mellitus: a case-control study in hospitalized patients. Eur. J. Endocrinol. 153(6), 837–844 (2005)

    Article  CAS  PubMed  Google Scholar 

  6. M. Sahin, L. Kebapcilar, A. Taslipinar, O. Azal, T. Ozgurtas, A. Corakci, E.O. Akgul, M.Y. Taslipinar, M. Yazici, M. Kutlu, Comparison of 1 mg and 2 mg overnight dexamethasone suppression tests for the screening of Cushing’s syndrome in obese patients. Intern. Med. 48(1), 33–39 (2009)

    Article  PubMed  Google Scholar 

  7. G. Mazziotti, C. Gazzaruso, A. Giustina, Diabetes in Cushing syndrome: basic and clinical aspects. Trends Endocrinol. Metab. 22(12), 499–506 (2011)

    Article  CAS  PubMed  Google Scholar 

  8. R. Giordano, F. Guaraldi, R. Berardelli, I. Karamouzis, V. D’Angelo, E. Marinazzo, A. Picu, E. Ghigo, E. Arvat, Glucose metabolism in patients with subclinical Cushing’s syndrome. Endocrine 41(3), 415–423 (2012). Review

    Article  CAS  PubMed  Google Scholar 

  9. Guidelines Committee European Society of Hypertension, European Society of Cardiology guidelines for the management of arterial hypertension. J. Hypertens. 21, 1011–1053 (2003)

    Article  Google Scholar 

  10. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 285, 2486–2497 (2001)

    Article  Google Scholar 

  11. S. Newsome, K. Chen, J. Hoang, J.D. Wilson, J.M. Potter, P.E. Hickman, Cushing’s syndrome in a clinic population with diabetes. Intern Med J 38(3), 178–182 (2008)

    Article  CAS  PubMed  Google Scholar 

  12. H. Liu, D.M. Bravata, J. Cabaccan, H. Raff, E. Ryzen, Elevated late-night salivary cortisol levels in elderly male type 2 diabetic veterans. Clin Endocrinol (Oxf) 63(6), 642–649 (2005)

    Article  CAS  Google Scholar 

  13. L. Gagliardi, I.M. Chapman, P. O’Loughlin, D.J. Torpy, Screening for subclinical Cushing’s syndrome in type 2 diabetes mellitus: low false-positive rates with nocturnal salivary cortisol. Horm. Metab. Res. 42(4), 280–284 (2010)

    Article  CAS  PubMed  Google Scholar 

  14. K. Mullan, N. Black, A. Thiraviaraj, P.M. Bell, C. Burgess, S.J. Hunter, D.R. McCance, H. Leslie, B. Sheridan, A.B. Atkinson, Is there value in routine screening for Cushing’s syndrome in patients with diabetes? J. Clin. Endocrinol. Metab. 95(5), 2262–2265 (2010)

    Article  CAS  PubMed  Google Scholar 

  15. M. Terzolo, G. Reimondo, I. Chiodini, R. Castello, R. Giordano, E. Ciccarelli, P. Limone, C. Crivellaro, I. Martinelli, M. Montini, O. Disoteo, B. Ambrosi, R. Lanzi, M. Arosio, S. Senni, A. Balestrieri, E. Solaroli, B. Madeo, R. De Giovanni, F. Strollo, R. Battista, A. Scorsone, V.A. Giagulli, D. Collura, A. Scillitani, R. Cozzi, M. Faustini-Fustini, A. Pia, R. Rinaldi, B. Allasino, G. Peraga, F. Tassone, P. Garofalo, E. Papini, G. Borretta, Screening of Cushing’s syndrome in outpatients with type 2 diabetes: results of a prospective multicentric study in Italy. J. Clin. Endocrinol. Metab. 97(10), 3467–3475 (2012)

    Article  CAS  PubMed  Google Scholar 

  16. A. Tabarin, P. Perez, Pros and cons of screening for occult Cushing syndrome. Nat Rev Endocrinol 7, 445–455 (2011)

    Article  PubMed  Google Scholar 

  17. T. Taniguchi, A. Hamasaki, M. Okamoto, Subclinical hypercortisolism in hospitalized patients with type 2 diabetes mellitus. Endocr. J. 55(2), 429–432 (2008)

    Article  CAS  PubMed  Google Scholar 

  18. G. Reimondo, A. Pia, B. Allasino, F. Tassone, S. Bovio, G. Borretta, A. Angeli, M. Terzolo, Screening of Cushing’s syndrome in adult patients with newly diagnosed diabetes mellitus. Clin Endocrinol (Oxf) 67(2), 225–229 (2007)

    Article  CAS  Google Scholar 

  19. C. Cronin, D. Igoe, M.J. Duffy, S.K. Cunningham, T.J. McKenna, The overnight dexamethasone test is a worthwhile screening procedure. Clin Endocrinol (Oxf) 33, 27–33 (1990)

    Article  CAS  Google Scholar 

  20. L. Kennedy, A.B. Atkinson, H. Johnston, B. Sheridan, D.R. Hadden, Serum cortisol concentrations during low dose dexamethasone suppression test to screen for Cushing’s syndrome. Br. Med. J. 289, 1188–1191 (1984)

    Article  CAS  Google Scholar 

  21. J. Newell-Price, P. Trainer, L. Perry, J. Wass, A. Grossman, M. Besser, A single sleeping midnight cortisol has 100% sensitivity for the diagnosis of Cushing’s syndrome. Clin Endocrinol (Oxf) 43, 545–550 (1995)

    Article  CAS  Google Scholar 

  22. C. Di Somma, R. Pivonello, S. Loche, A. Faggiano, P. Marzullo, A. Di Sarno, M. Klain, M. Salvatore, G. Lombardi, A. Colao, Severe impairment of bone mass and turnover in Cushing’s disease: comparison between childhood-onset and adulthood-onset disease. Clin Endocrinol (Oxf) 56, 153–158 (2002)

    Article  Google Scholar 

  23. L. Tauchmanovà, R. Pivonello, C. Di Somma, R. Rossi, M.C. De Martino, L. Camera, M. Klain, M. Salvatore, G. Lombardi, A. Colao, Bone demineralization and vertebral fractures in endogenous cortisol excess: role of disease etiology and gonadal status. J. Clin. Endocrinol. Metab. 91, 1779–1784 (2006)

    Article  PubMed  Google Scholar 

  24. G. Arnaldi, A. Angeli, A.B. Atkinson, X. Bertagna, F. Cavagnini, G.P. Chrousos, G.A. Fava, J.W. Findling, R.C. Gaillard, A.B. Grossman, B. Kola, A. Lacroix, T. Mancini, F. Mantero, J. Newell-Price, L.K. Nieman, N. Sonino, M.L. Vance, A. Giustina, M. Boscaro, Diagnosis and complications of Cushing’s syndrome: a consensus statement. J. Clin. Endocrinol. Metab. 88, 5593–5602 (2003)

    Article  CAS  PubMed  Google Scholar 

  25. J. Newell-Price, P. Trainer, M. Besser, A. Grossman, The diagnosis and differential diagnosis of Cushing’s syndrome and pseudo-Cushing’s states. Endocr. Rev. 19, 647–672 (1998)

    CAS  PubMed  Google Scholar 

  26. M. Boscaro, L. Barzon, N. Sonino, The diagnosis of Cushing’s syndrome: atypical presentations and laboratory shortcomings. Arch. Intern. Med. 160, 3045–3053 (2000)

    Article  CAS  PubMed  Google Scholar 

  27. H. Raff, Update on late-night salivary cortisol for the diagnosis of Cushing’s syndrome: methodological considerations. Endocrine. 44(2), 346–349 (2013)

    Article  CAS  PubMed  Google Scholar 

  28. Z.E. Belaya, A.V. Iljin, G.A. Melnichenko, L.Y. Rozhinskaya, N.V. Dragunova, L.K. Dzeranova, S.A. Butrova, E.A. Troshina, I.I. Dedov, Diagnostic performance of late-night salivary cortisol measured by automated electrochemiluminescence immunoassay in obese and overweight patients referred to exclude Cushing’s syndrome. Endocrine. 41(3), 494–500 (2012)

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Endocrinology and Metabolic Diseases, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey

    Askin Gungunes, Taner Demirci, Bekir Ucan, Evrim Cakir, Muyesser Sayki Arslan, Ilknur Ozturk Unsal, Basak Karbek, Mustafa Calıskan, Mustafa Ozbek, Erman Cakal & Tuncay Delibasi

  2. Department of Endocrinology and Metabolic Diseases, School of Medicine, Ankara University, Ankara, Turkey

    Mustafa Sahin

Authors
  1. Askin Gungunes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mustafa Sahin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Taner Demirci
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bekir Ucan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Evrim Cakir
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Muyesser Sayki Arslan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ilknur Ozturk Unsal
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Basak Karbek
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mustafa Calıskan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mustafa Ozbek
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Erman Cakal
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Tuncay Delibasi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Askin Gungunes.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gungunes, A., Sahin, M., Demirci, T. et al. Cushing’s syndrome in type 2 diabetes patients with poor glycemic control. Endocrine 47, 895–900 (2014). https://doi.org/10.1007/s12020-014-0260-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-014-0260-8

Keywords

Search

Navigation