Screening of Cushing's Syndrome in Outpatients with Type 2 Diabetes: Results of a Prospective Multicentric Study in Italy

被引：71

作者：

Terzolo, Massimo ^{[1
]}

Reimondo, Giuseppe ^{[1
]}

Chiodini, Iacopo ^{[2
]}

Castello, Roberto ^{[5
]}

Giordano, Roberta ^{[1
]}

Ciccarelli, Enrica ^{[6
]}

Limone, Paolo ^{[7
]}

Crivellaro, Claudio ^{[8
]}

Martinelli, Irma ^{[9
]}

Montini, Marcella ^{[10
]}

Disoteo, Olga ^{[12
]}

Ambrosi, Bruno ^{[3
]}

Lanzi, Roberto ^{[13
]}

Arosio, Maura ^{[4
]}

Senni, Sanzio ^{[14
]}

Balestrieri, Antonio ^{[15
]}

Solaroli, Erica ^{[16
]}

Madeo, Bruno ^{[17
]}

De Giovanni, Raffaella ^{[18
]}

Strollo, Felice ^{[19
]}

Battista, Rodolfo ^{[20
]}

Scorsone, Alessandro ^{[21
]}

Giagulli, Vito A. ^{[22
]}

Collura, Daniela ^{[23
]}

Scillitani, Aldo ^{[24
]}

Cozzi, Renato ^{[11
]}

Faustini-Fustini, Marco ^{[16
]}

Pia, Anna ^{[25
]}

Rinaldi, Roberta ^{[26
]}

Allasino, Barbara ^{[1
]}

Peraga, Giulia ^{[1
]}

Tassone, Francesco ^{[25
]}

Garofalo, Piernicola ^{[27
]}

Papini, Enrico ^{[26
]}

Borretta, Giorgio ^{[25
]}

机构：

[1] Univ Turin, Dipartimento Sci Clin & Biol, Azienda Osped Univ San Luigi Gonzaga, I-10043 Turin, Italy

[2] Univ Milan, Dipartimento Endocrinol & Diabetol, Osped Maggiore Policlin Inst Ricovero & Cura Cara, I-20122 Milan, Italy

[3] Univ Milan, Div Endocrinol & Diabetol, Dipartimento Sci Medicochirurg, Inst Ricovero & Cura Carattere Sci Policlin San D, I-20122 Milan, Italy

[4] Univ Milan, Dipartimento Sci Med, Osped San Giuseppe, Div Endocrinol & Diabetol, I-20122 Milan, Italy

[5] Azienda Osped Univ Integrata Verona, Dipartimento Med Gen & Endocrinol, Verona, Italy

[6] Osped E Valdese, SS Patol Endocrine & Metab, I-10138 Turin, Italy

[7] Azienda Osped Ordine Mauriziano, I-10125 Turin, Italy

[8] Osped Cent Bolzano, Dipartimento Med Interna, Div Endocrinol, I-39100 Bolzano, Italy

[9] Osped S Antonio Abate, Dipartimento Endocrinol, I-21013 Gallarate, Italy

[10] Osped Riuniti Bergamo, Dipartimento Endocrinol, I-24128 Bergamo, Italy

[11] Osped Niguarda Ca Granda, Dipartimento Endocrinol, I-20162 Milan, Italy

[12] Osped Niguarda Ca Granda, Dipartimento Diabetol, I-20162 Milan, Italy

[13] Inst Ricovero & Cura Carattere Sci Fdn Ctr San Ra, Dipartimento Med Interna & Specialist, Div Endocrinol, I-20132 Milan, Italy

[14] AUSL Ravenna, Unita Operat Semplice Endocrinol, I-48100 Ravenna, Italy

[15] Osped Gen Provinciale M Bufalini, Dipartimento Malattie Metab & Diabetol, I-47023 Cesena, Italy

[16] Osped Maggiore Bellaria, Dipartimento Endocrinol, Bologna, Italy

[17] Nuovo Osped Civile S Agostino Estense di Baggiova, Dipartimento Med Endocrinol Metab & Geriatria, I-41100 Modena, Italy

[18] Osped Ceccarini, Dipartimento Med Gen, I-47900 Riccione, Italy

[19] Inst Ricovero Cura Carattere Scientifico, Ist Nazl Ricovero & Cura Anziani, Unita Operat Endocrinol, I-00164 Rome, Italy

[20] Ctr Diabetol Osped Santissima, Trinita, Frosinone, Italy

[21] Osped Civ Partin, Unita Operat Complessa Diabetol, I-90047 Palermo, Italy

[22] Presidio Osped Monopoli Conversano, Dipartimento Malattie Metab & Endocrinol, I-70043 Bari, Italy

[23] Ctr Catanese Med & Chirurg, I-95029 Catania, Italy

[24] Inst Ricovero & Cura Carattere Sci, Osped Casa Sollievo Sofferenza, Dipartimento Endocrinol, I-71013 San Giovanni Rotondo, Italy

[25] Azienda Osped Santa Croce & Carle, Dipartimento Endocrinol, I-12100 Cuneo, Italy

[26] Osped Regina Apostolurum, Dipartimento Endocrinol & Malattie Metab, I-00041 Albano Laziale, Italy

[27] Osped Cervello, Dipartimento Endocrinol Eta Evolut, I-90146 Palermo, Italy

来源：

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM | 2012年 / 97卷 / 10期

关键词：

ADULT PATIENTS; DIAGNOSIS; POPULATION; MORBIDITY; MORTALITY; MELLITUS; DISEASE;

D O I：

10.1210/jc.2012-1323

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Context: 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. Objective: Our aim was to evaluate the prevalence of unsuspected Cushing's syndrome among outpatients with type 2 diabetes. Design and Setting: This was a cross-sectional prospective study in 24 diabetes clinics across Italy. Patients: 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. Results: Forty patients failed to suppress serum cortisol less than 5.0 mu g/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 mu g/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. Conclusions: 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. (J Clin Endocrinol Metab 97: 3467-3475, 2012)

引用

页码：3467 / 3475

页数：9

共 34 条

[1] Diagnosis and complications of Cushing's syndrome: A consensus statement [J].

Arnaldi, G ;

Angeli, A ;

Atkinson, AB ;

Bertagna, X ;

Cavagnini, F ;

Chrousos, GP ;

Fava, GA ;

Findling, JW ;

Gaillard, RC ;

Grossman, AB ;

Kola, B ;

Lacroix, A ;

Mancini, T ;

Mantero, F ;

Newell-Price, J ;

Nieman, LK ;

Sonino, N ;

Vance, ML ;

Giustina, A ;

Boscaro, M .

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2003, 88 (12) :5593-5602

[2] Mortality and morbidity in Cushing's syndrome in New Zealand [J].

Bolland, Mark J. ;

Holdaway, Ian M. ;

Berkeley, Juliet E. ;

Lim, Sarina ;

Dransfield, Will J. ;

Conaglen, John V. ;

Croxson, Michael S. ;

Gamble, Greg D. ;

Hunt, Penny J. ;

Toomath, Robyn J. .

CLINICAL ENDOCRINOLOGY, 2011, 75 (04) :436-442

[3] Evaluation of a simple policy for pre- and post-prandial blood glucose self-monitoring in people with type 2 diabetes not on insulin [J].

Bonomo, Katia ;

De Salve, Alessandro ;

Fiora, Elisa ;

Mularoni, Elena ;

Massucco, Paola ;

Poy, Paolo ;

Pomero, Alice ;

Cavalot, Franco ;

Anfossi, Giovanni ;

Trovati, Mariella .

DIABETES RESEARCH AND CLINICAL PRACTICE, 2010, 87 (02) :246-251

[4] Cushing's syndrome [J].

Boscaro, M ;

Barzon, L ;

Fallo, F ;

Sonino, N .

LANCET, 2001, 357 (9258) :783-791

[5]

Bray GA, 2001, OBESITY, P294

[6] Increased diagnostic probability of subclinical Cushing's syndrome in a population sample of overweight adult patients with type 2 diabetes mellitus [J].

Caetano, Maria Silvia S. ;

Silva, Regina Do Carmo ;

Kater, Claudio E. .

ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA, 2007, 51 (07) :1118-1127

[7] Occult Cushing's syndrome in type-2 diabetes [J].

Catargi, B ;

Rigalleau, V ;

Poussin, A ;

Ronci-Chaix, N ;

Bex, V ;

Vergnot, V ;

Gin, H ;

Roger, P ;

Tabarin, A .

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2003, 88 (12) :5808-5813

[8] Diagnosis and Treatment of Subclinical Hypercortisolism [J].

Chiodini, Iacopo .

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2011, 96 (05) :1223-1236

[9] Association of subclinical hypercortisolism with type 2 diabetes mellitus: a case-control study in hospitalized patients [J].

Chiodini, L ;

Torlontano, M ;

Scillitani, A ;

Arosio, M ;

Bacci, S ;

Di Lembo, S ;

Epaminonda, P ;

Augello, G ;

Enrini, R ;

Ambrosi, B ;

Adda, G ;

Trischitta, V .

EUROPEAN JOURNAL OF ENDOCRINOLOGY, 2005, 153 (06) :837-844

[10] Mortality and Morbidity in Cushing's Disease over 50 Years in Stoke-on-Trent, UK: Audit and Meta-Analysis of Literature [J].

Clayton, R. N. ;

Raskauskiene, D. ;

Reulen, R. C. ;

Jones, P. W. .

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2011, 96 (03) :632-642

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