Abstract
OBJECTIVE
Diabetes or impaired glucose tolerance are common in patients with Cushing’s syndrome (CS). In this study we investigated the incidence of subclinical Cushing’s syndrome (SCS) in type 2 diabetic patients with poor and good metabolic control and the relationship between blood glucose and Cortisol levels.
DESIGN
A total of 400 type 2 diabetes mellitus (T2DM) patients (Group A, HbA1c ≥8%, n=250; Group B, HbA1c ≤6.5%, n=150) were included in the study. Biochemical tests followed by the 1 mg dexamethasone suppression test (DST) were performed. If post-DST Cortisol levels were above 1.8 µg/dl (non-suppressed group), the 2 mg DST test was performed for 2 days. Among the patients, post-DST Cortisol of at least 1.8 µg/dL and midnight serum Cortisol levels of at least 7.5 µg/dL confirmed the diagnosis of CS.
RESULTS
While SCS was observed in 5 patients (2%) in Group A, no case was observed in group B. There was a statistically significant difference between groups for basal Cortisol and post-DST Cortisol results (p<0.001 and p<0.001, respectively). Microvascular complication rates were higher in the non-suppressed group (p=0.007). Post-DST Cortisol levels had a positive correlation with the number of complications and HbA1c levels (respectively r=0.213, p<0.001, and r=0.191, p<0.001). Multivariate regression analysis revealed that durations of DM, HbA1c level, and post 1 mg DST Cortisol levels were associated with the number of complications.
CONCLUSIONS
This study shows the presence of SCS in a notable number in T2DM patients having poor metabolic control. Screening with 1 mg and 2 mg DST of T2DM patients with poor metabolic control who are also obese and hypertensive and have microvascular complications may be an appropriate method for detection of SCS.
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Cansu, G.B., Atılgan, S., Balcı, M.K. et al. Which type 2 diabetes mellitus patients should be screened for subclinical Cushing’s syndrome?. Hormones 16, 22–32 (2017). https://doi.org/10.14310/horm.2002.1716
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DOI: https://doi.org/10.14310/horm.2002.1716