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DeFronzo RA, Auchus RJ, Bancos I, Blonde L, Busch RS, Buse JB, Findling JW, Fonseca VA, Frias JP, Hamidi O, Handelsman Y, Pratley RE, Rosenstock J, Tudor IC, Moraitis AG, Einhorn D. Study protocol for a prospective, multicentre study of hypercortisolism in patients with difficult-to-control type 2 diabetes (CATALYST): prevalence and treatment with mifepristone. BMJ Open 2024; 14:e081121. [PMID: 39013654 PMCID: PMC11253743 DOI: 10.1136/bmjopen-2023-081121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 06/17/2024] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION Even with recent treatment advances, type 2 diabetes (T2D) remains poorly controlled for many patients, despite the best efforts to adhere to therapies and lifestyle modifications. Although estimates vary, studies indicate that in >10% of individuals with difficult-to-control T2D, hypercortisolism may be an underlying contributing cause. To better understand the prevalence of hypercortisolism and the impact of its treatment on T2D and associated comorbidities, we describe the two-part Hyper c ortisolism in P at ients with Difficult to Control Type 2 Di a betes Despite Receiving Standard-of-Care Therapies: Preva l ence and Treatment with Korl y m® (Mifepri st one) (CATALYST) trial. METHODS AND ANALYSIS In part 1, approximately 1000 participants with difficult-to-control T2D (haemoglobin A1c (HbA1c) 7.5%-11.5% despite multiple therapies) are screened with a 1 mg dexamethasone suppression test (DST). Those with post-DST cortisol >1.8 µg/dL and dexamethasone level ≥140 ng/dL are identified to have hypercortisolism (part 1 primary endpoint), have morning adrenocorticotropic hormone (ACTH) and dehydroepiandrosterone sulfate (DHEAS) measured and undergo a non-contrast adrenal CT scan. Those requiring evaluation for elevated ACTH are referred for care outside the study; those with ACTH and DHEAS in the range may advance to part 2, a randomised, double-blind, placebo-controlled trial to evaluate the impact of treating hypercortisolism with the competitive glucocorticoid receptor antagonist mifepristone (Korlym®). Participants are randomised 2:1 to mifepristone or placebo for 24 weeks, stratified by the presence/absence of an abnormal adrenal CT scan. Mifepristone is dosed at 300 mg once daily for 4 weeks, then 600 mg daily based on tolerability and clinical improvement, with an option to increase to 900 mg. The primary endpoint of part 2 assesses changes in HbA1c in participants with hypercortisolism with or without abnormal adrenal CT scan. Secondary endpoints include changes in antidiabetes medications, cortisol-related comorbidities and quality of life. ETHICS AND DISSEMINATION The study has been approved by Cleveland Clinic IRB (Cleveland, Ohio, USA) and Advarra IRB (Columbia, Maryland, USA). Findings will be presented at scientific meetings and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05772169.
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Affiliation(s)
- Ralph A DeFronzo
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Richard J Auchus
- Departments of Pharmacology and Internal Medicine, Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Irina Bancos
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lawrence Blonde
- Ochsner Diabetes Clinical Research Unit, Frank Riddick Diabetes Institute, Endocrinology Department, Ochsner Health, New Orleans, Louisiana, USA
| | - Robert S Busch
- Albany Medical College: Community Endocrine Group, Albany, New York, USA
| | - John B Buse
- The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | | | - Vivian A Fonseca
- Section of Endocrinology, Department of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Juan P Frias
- Velocity Clinical Research, Los Angeles, California, USA
| | - Oksana Hamidi
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Richard E Pratley
- AdventHealth Translational Research Institute, Orlando, Florida, USA
| | | | | | | | - Daniel Einhorn
- Corcept Therapeutics Incorporated, Menlo Park, California, USA
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Antar SA, Ashour NA, Sharaky M, Khattab M, Ashour NA, Zaid RT, Roh EJ, Elkamhawy A, Al-Karmalawy AA. Diabetes mellitus: Classification, mediators, and complications; A gate to identify potential targets for the development of new effective treatments. Biomed Pharmacother 2023; 168:115734. [PMID: 37857245 DOI: 10.1016/j.biopha.2023.115734] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023] Open
Abstract
Nowadays, diabetes mellitus has emerged as a significant global public health concern with a remarkable increase in its prevalence. This review article focuses on the definition of diabetes mellitus and its classification into different types, including type 1 diabetes (idiopathic and fulminant), type 2 diabetes, gestational diabetes, hybrid forms, slowly evolving immune-mediated diabetes, ketosis-prone type 2 diabetes, and other special types. Diagnostic criteria for diabetes mellitus are also discussed. The role of inflammation in both type 1 and type 2 diabetes is explored, along with the mediators and potential anti-inflammatory treatments. Furthermore, the involvement of various organs in diabetes mellitus is highlighted, such as the role of adipose tissue and obesity, gut microbiota, and pancreatic β-cells. The manifestation of pancreatic Langerhans β-cell islet inflammation, oxidative stress, and impaired insulin production and secretion are addressed. Additionally, the impact of diabetes mellitus on liver cirrhosis, acute kidney injury, immune system complications, and other diabetic complications like retinopathy and neuropathy is examined. Therefore, further research is required to enhance diagnosis, prevent chronic complications, and identify potential therapeutic targets for the management of diabetes mellitus and its associated dysfunctions.
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Affiliation(s)
- Samar A Antar
- Center for Vascular and Heart Research, Fralin Biomedical Research Institute, Virginia Tech, Roanoke, VA 24016, USA; Department of Pharmacology and Biochemistry, Faculty of Pharmacy, Horus University, New Damietta 34518, Egypt
| | - Nada A Ashour
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tanta University, Tanta 31527, Egypt
| | - Marwa Sharaky
- Cancer Biology Department, Pharmacology Unit, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
| | - Muhammad Khattab
- Department of Chemistry of Natural and Microbial Products, Division of Pharmaceutical and Drug Industries, National Research Centre, Cairo, Egypt
| | - Naira A Ashour
- Department of Neurology, Faculty of Physical Therapy, Horus University, New Damietta 34518, Egypt
| | - Roaa T Zaid
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Ahram Canadian University, 6th of October City, Giza 12566, Egypt
| | - Eun Joo Roh
- Chemical and Biological Integrative Research Center, Korea Institute of Science and Technology (KIST), Seoul 02792, Republic of Korea; Division of Bio-Medical Science & Technology, University of Science and Technology, Daejeon 34113, Republic of Korea
| | - Ahmed Elkamhawy
- BK21 FOUR Team and Integrated Research Institute for Drug Development, College of Pharmacy, Dongguk University-Seoul, Goyang 10326, Republic of Korea; Department of Pharmaceutical Organic Chemistry, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt.
| | - Ahmed A Al-Karmalawy
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Ahram Canadian University, 6th of October City, Giza 12566, Egypt; Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Horus University-Egypt, New Damietta 34518, Egypt
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Braun LT, Vogel F, Rubinstein G, Zopp S, Nowak E, Constantinescu G, Masjkur J, Detomas M, Pamporaki C, Altieri B, Deutschbein T, Quinkler M, Beuschlein F, Reincke M. Lack of sensitivity of diagnostic Cushing-scores in Germany: a multicenter validation. Eur J Endocrinol 2023; 188:6979714. [PMID: 36651158 DOI: 10.1093/ejendo/lvac016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Endogenous Cushing's syndrome (CS) is a severe condition, often diagnosed at a late stage. To reduce mortality, early diagnosis plays an important role. Two screening tools for early identification of patients with CS have been developed in multicentric cohorts, but have not yet been validated in cohorts with different geographic backgrounds. DESIGN We validated the Spanish score published by Leon-Justel et al. in 2016 and the Italian score by Parasiliti-Caprino et al. published in 2021 in our cohort. METHODS In the multicentric German Cushing registry, patients with confirmed and expected but ruled out Cushing's syndrome are prospectively diagnosed and followed up. We validated both scores in a cohort of 458 subjects: 176 patients with confirmed CS and 282 patients with suspected, but finally excluded CS. RESULTS Using the Spanish score, 17.5% of our patients with proven CS biochemical screening would not have been recommended. This concerned patients with pituitary CS (22%) and with adrenal CS (10%). On the contrary, only 14% of patients without CS would have received a recommendation for biochemical screening. Using the Italian score, 29% of patients with proven CS were classified into the low-risk classes not recommended for biochemical screening. This mostly affected patients with adrenal (31%) and pituitary CS (30%). About 12% of subjects without CS would have received a biochemical screening recommendation. CONCLUSIONS Both scores had limited sensitivity and high specificity in a German validation cohort. Further research is necessary to develop a screening score, which is effective in different healthcare systems and ethnicities.
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Affiliation(s)
- Leah T Braun
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich 80336, Germany
| | - Frederick Vogel
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich 80336, Germany
| | - German Rubinstein
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich 80336, Germany
| | - Stephanie Zopp
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich 80336, Germany
| | - Elisabeth Nowak
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich 80336, Germany
| | - Georgiana Constantinescu
- Department of Internal Medicine III, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden 01307, Germany
| | - Jimmy Masjkur
- Department of Internal Medicine III, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden 01307, Germany
| | - Mario Detomas
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg 97080, Germany
| | - Christina Pamporaki
- Department of Internal Medicine III, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden 01307, Germany
| | - Barbara Altieri
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg 97080, Germany
| | - Timo Deutschbein
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg 97080, Germany
- Medicover Oldenburg MVZ, Oldenburg 26122, Germany
| | | | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich 80336, Germany
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich (USZ) und Universität Zürich (UZH), Zürich 8091, Switzerland
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich 80336, Germany
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Assessment of the diagnostic performance of the 1 mg dexamethasone suppression test in class 3 obese patients. Endocr Regul 2022; 56:265-270. [DOI: 10.2478/enr-2022-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Objective. This study was aimed to evaluate the prevalence of Cushing’s syndrome and the diagnostic performance of the 1 mg dexamethasone suppression test in class 3 obese patients.
Methods. Anthropometric measurements and other laboratory data, including 1 mg dexamethasone suppression test of 753 class 3 obese patients, who applied to the Endocrinology and Metabolism Outpatient Clinic for the pre-bariatric surgery evaluation between 2011 and 2020, were evaluated retrospectively.
Results. An abnormal response to the 1 mg dexamethasone suppression test (cortisol ≥1.8 mcg/dl) was observed in 24 patients and the presence of Cushing’s syndrome was confirmed by additional tests in 6 patients. The prevalence of abnormal dexamethasone suppression test was 3.18% and the prevalence of Cushing’s syndrome 0.79%. The specificity value was determined as 97.5% for 1 mg dexamethasone suppression test with cortisol threshold value ≥1.8 mcg/dl.
Conclusions. The prevalence of Cushing’s syndrome was found to be low in class 3 obese patients and 1 mg of dexamethasone suppression test had a very sufficient performance for Cushing’s syndrome screening in this patient group.
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Braun LT, Vogel F, Zopp S, Marchant Seiter T, Rubinstein G, Berr CM, Künzel H, Beuschlein F, Reincke M. Whom Should We Screen for Cushing Syndrome? The Endocrine Society Practice Guideline Recommendations 2008 Revisited. J Clin Endocrinol Metab 2022; 107:e3723-e3730. [PMID: 35730067 PMCID: PMC9387700 DOI: 10.1210/clinem/dgac379] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Cushing syndrome (CS) is a rare and serious disease with high mortality. Patients are often diagnosed late in the course of the disease. OBJECTIVE This work investigated whether defined patient populations should be screened outside the at-risk populations defined in current guidelines. METHODS As part of the prospective German Cushing registry, we studied 377 patients with suspected CS. The chief complaint for CS referral was documented. Using urinary free cortisol, late-night salivary cortisol, and the 1-mg dexamethasone suppression test as well as long-term clinical observation, CS was confirmed in 93 patients and ruled out for the remaining 284. RESULTS Patients were referred for 18 key symptoms, of which 5 were more common in patients with CS than in those in whom CS was ruled out: osteoporosis (8% vs 2%; P = .02), adrenal incidentaloma (17% vs 8%, P = 0.01), metabolic syndrome (11% vs 4%; P = .02), myopathy (10% vs 2%; P < .001), and presence of multiple symptoms (16% vs 1%; P < .001). Obesity was more common in patients in whom CS was ruled out (30% vs 4%, P < .001), but recent weight gain was prominent in those with CS. A total of 68 of 93 patients with CS (73%) had typical chief complaints, as did 106 of 284 of patients with ruled-out CS status (37%) according to the Endocrine Society practice guideline 2008. CONCLUSION The 2008 Endocrine Society Practice guideline for screening and diagnosis of CS defined at-risk populations that should undergo testing. These recommendations are still valid in 2022.
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Affiliation(s)
- Leah T Braun
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Frederick Vogel
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Stephanie Zopp
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Thomas Marchant Seiter
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - German Rubinstein
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Christina M Berr
- Department of Endocrinology, I. Medical Clinic, University Hospital, University of Augsburg, 86156 Augsburg, Germany
| | - Heike Künzel
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich (USZ) und Universität Zürich (UZH), 8091 Zurich, Switzerland
| | - Martin Reincke
- Correspondence: Martin Reincke, MD, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ziemssenstraße 5, 80336 Munich, Germany.
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Tabarin A, Assié G, Barat P, Bonnet F, Bonneville JF, Borson-Chazot F, Bouligand J, Boulin A, Brue T, Caron P, Castinetti F, Chabre O, Chanson P, Corcuff JB, Cortet C, Coutant R, Dohan A, Drui D, Espiard S, Gaye D, Grunenwald S, Guignat L, Hindie E, Illouz F, Kamenicky P, Lefebvre H, Linglart A, Martinerie L, North MO, Raffin-Samson ML, Raingeard I, Raverot G, Raverot V, Reznik Y, Taieb D, Vezzosi D, Young J, Bertherat J. Consensus statement by the French Society of Endocrinology (SFE) and French Society of Pediatric Endocrinology & Diabetology (SFEDP) on diagnosis of Cushing's syndrome. ANNALES D'ENDOCRINOLOGIE 2022; 83:119-141. [PMID: 35192845 DOI: 10.1016/j.ando.2022.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cushing's syndrome is defined by prolonged exposure to glucocorticoids, leading to excess morbidity and mortality. Diagnosis of this rare pathology is difficult due to the low specificity of the clinical signs, the variable severity of the clinical presentation, and the difficulties of interpretation associated with the diagnostic methods. The present consensus paper by 38 experts of the French Society of Endocrinology and the French Society of Pediatric Endocrinology and Diabetology aimed firstly to detail the circumstances suggesting diagnosis and the biologic diagnosis tools and their interpretation for positive diagnosis and for etiologic diagnosis according to ACTH-independent and -dependent mechanisms. Secondly, situations making diagnosis complex (pregnancy, intense hypercortisolism, fluctuating Cushing's syndrome, pediatric forms and genetically determined forms) were detailed. Lastly, methods of surveillance and diagnosis of recurrence were dealt with in the final section.
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Affiliation(s)
- Antoine Tabarin
- Service Endocrinologie, Diabète et Nutrition, Université, Hôpital Haut-Leveque CHU de Bordeaux, 33604 Pessac, France.
| | - Guillaume Assié
- Centre de Référence Maladies Rares de la Surrénale (CRMRS), Service d'Endocrinologie, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | - Pascal Barat
- Unité d'Endocrinologie-Diabétologie-Gynécologie-Obésité Pédiatrique, Hôpital des Enfants CHU Bordeaux, Bordeaux, France
| | - Fidéline Bonnet
- UF d'Hormonologie Hôpital Cochin, Université de Paris, Institut Cochin Inserm U1016, CNRS UMR8104, Paris, France
| | | | - Françoise Borson-Chazot
- Fédération d'Endocrinologie, Hôpital Louis-Pradel, Hospices Civils de Lyon, INSERM U1290, Université Lyon1, 69002 Lyon, France
| | - Jérôme Bouligand
- Faculté de Médecine Paris-Saclay, Unité Inserm UMRS1185 Physiologie et Physiopathologie Endocriniennes, Paris, France
| | - Anne Boulin
- Service de Neuroradiologie, Hôpital Foch, 92151 Suresnes, France
| | - Thierry Brue
- Aix-Marseille Université, Institut National de la Recherche Scientifique (INSERM) U1251, Marseille Medical Genetics, Marseille, France; Assistance publique-Hôpitaux de Marseille, Service d'Endocrinologie, Hôpital de la Conception, Centre de Référence Maladies Rares HYPO, 13005 Marseille, France
| | - Philippe Caron
- Service d'Endocrinologie et Maladies Métaboliques, Pôle Cardiovasculaire et Métabolique, CHU Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France
| | - Frédéric Castinetti
- Aix-Marseille Université, Institut National de la Recherche Scientifique (INSERM) U1251, Marseille Medical Genetics, Marseille, France; Assistance publique-Hôpitaux de Marseille, Service d'Endocrinologie, Hôpital de la Conception, Centre de Référence Maladies Rares HYPO, 13005 Marseille, France
| | - Olivier Chabre
- Université Grenoble Alpes, UMR 1292 INSERM-CEA-UGA, Endocrinologie, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Philippe Chanson
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Le Kremlin-Bicêtre, France
| | - Jean Benoit Corcuff
- Laboratoire d'Hormonologie, Service de Médecine Nucléaire, CHU Bordeaux, Laboratoire NutriNeuro, UMR 1286 INRAE, Université de Bordeaux, Bordeaux, France
| | - Christine Cortet
- Service d'Endocrinologie, Diabétologie, Métabolisme et Nutrition, CHU de Lille, Lille, France
| | - Régis Coutant
- Service d'Endocrinologie Pédiatrique, CHU Angers, Centre de Référence, Centre Constitutif des Maladies Rares de l'Hypophyse, CHU Angers, Angers, France
| | - Anthony Dohan
- Department of Radiology A, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Delphine Drui
- Service Endocrinologie-Diabétologie et Nutrition, l'institut du Thorax, CHU Nantes, 44092 Nantes cedex, France
| | - Stéphanie Espiard
- Service d'Endocrinologie, Diabétologie, Métabolisme et Nutrition, INSERM U1190, Laboratoire de Recherche Translationnelle sur le Diabète, 59000 Lille, France
| | - Delphine Gaye
- Service de Radiologie, Hôpital Haut-Lêveque, CHU de Bordeaux, 33604 Pessac, France
| | - Solenge Grunenwald
- Service d'Endocrinologie, Hôpital Larrey, CHU Toulouse, Toulouse, France
| | - Laurence Guignat
- Centre de Référence Maladies Rares de la Surrénale (CRMRS), Service d'Endocrinologie, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | - Elif Hindie
- Service de Médecine Nucléaire, CHU de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Frédéric Illouz
- Centre de Référence Maladies Rares de la Thyroïde et des Récepteurs Hormonaux, Service Endocrinologie-Diabétologie-Nutrition, CHU Angers, 49933 Angers cedex 9, France
| | - Peter Kamenicky
- Assistance publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Hervé Lefebvre
- Service d'Endocrinologie, Diabète et Maladies Métaboliques, CHU de Rouen, Rouen, France
| | - Agnès Linglart
- Paris-Saclay University, AP-HP, Endocrinology and Diabetes for Children, Reference Center for Rare Disorders of Calcium and Phosphate Metabolism, Filière OSCAR, and Platform of Expertise for Rare Disorders, INSERM, Physiologie et Physiopathologie Endocriniennes, Bicêtre Paris-Saclay Hospital, Le Kremlin-Bicêtre, France
| | - Laetitia Martinerie
- Service d'Endocrinologie Pédiatrique, CHU Robert-Debré, AP-HP, Paris, France; Université de Paris, Paris, France
| | - Marie Odile North
- Service de Génétique et Biologie Moléculaire, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | - Marie Laure Raffin-Samson
- Service d'Endocrinologie Nutrition, Hôpital Ambroise-Paré, GHU Paris-Saclay, AP-HP Boulogne, EA4340, Université de Versailles-Saint-Quentin, Paris, France
| | - Isabelle Raingeard
- Maladies Endocriniennes, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France
| | - Gérald Raverot
- Fédération d'Endocrinologie, Centre de Référence Maladies Rares Hypophysaires, "Groupement Hospitalier Est", Hospices Civils de Lyon, Lyon, France
| | - Véronique Raverot
- Hospices Civils de Lyon, LBMMS, Centre de Biologie Est, Service de Biochimie et Biologie Moléculaire, 69677 Bron cedex, France
| | - Yves Reznik
- Department of Endocrinology and Diabetology, CHU Côte-de-Nacre, 14033 Caen cedex, France; University of Caen Basse-Normandie, Medical School, 14032 Caen cedex, France
| | - David Taieb
- Aix-Marseille Université, CHU La Timone, AP-HM, Marseille, France
| | - Delphine Vezzosi
- Service d'Endocrinologie, Hôpital Larrey, CHU Toulouse, Toulouse, France
| | - Jacques Young
- Assistance publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Jérôme Bertherat
- Centre de Référence Maladies Rares de la Surrénale (CRMRS), Service d'Endocrinologie, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
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Kokkinopoulou I, Diakoumi A, Moutsatsou P. Glucocorticoid Receptor Signaling in Diabetes. Int J Mol Sci 2021; 22:ijms222011173. [PMID: 34681832 PMCID: PMC8537243 DOI: 10.3390/ijms222011173] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 12/20/2022] Open
Abstract
Stress and depression increase the risk of Type 2 Diabetes (T2D) development. Evidence demonstrates that the Glucocorticoid (GC) negative feedback is impaired (GC resistance) in T2D patients resulting in Hypothalamic-Pituitary-Adrenal (HPA) axis hyperactivity and hypercortisolism. High GCs, in turn, activate multiple aspects of glucose homeostasis in peripheral tissues leading to hyperglycemia. Elucidation of the underlying molecular mechanisms revealed that Glucocorticoid Receptor (GR) mediates the GC-induced dysregulation of glucose production, uptake and insulin signaling in GC-sensitive peripheral tissues, such as liver, skeletal muscle, adipose tissue, and pancreas. In contrast to increased GR peripheral sensitivity, an impaired GR signaling in Peripheral Blood Mononuclear Cells (PBMCs) of T2D patients, associated with hyperglycemia, hyperlipidemia, and increased inflammation, has been shown. Given that GR changes in immune cells parallel those in brain, the above data implicate that a reduced brain GR function may be the biological link among stress, HPA hyperactivity, hypercortisolism and hyperglycemia. GR polymorphisms have also been associated with metabolic disturbances in T2D while dysregulation of micro-RNAs—known to target GR mRNA—has been described. Collectively, GR has a crucial role in T2D, acting in a cell-type and context-specific manner, leading to either GC sensitivity or GC resistance. Selective modulation of GR signaling in T2D therapy warrants further investigation.
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Winzinger EP, Jandikova H, Haase M, Knauerhase A, Winzinger T, Schott M, Willenberg HS. DHEAS and Differential Blood Counts as Indirect Signs of Glucocorticoid Excess in Adrenal Non-Producing Adenomas. Horm Metab Res 2021; 53:512-519. [PMID: 34384108 DOI: 10.1055/a-1539-6442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The majority of incidentally discovered adrenal tumors are later characterized as non-producing adrenocortical adenomas (NPA). We asked whether laboratory abnormalities in parameters that reflect glucocorticoid action can be found in patients with NPA despite their nature of being clinically unapparent. Since glucocorticoids are potent immunosuppressants we studied blood counts and differential blood counts along with corticotropin and dehydroepiandrostenedione sulfate (DHEAS) blood concentrations, as well as cortisol values before and after an overnight 1 mg dexamethasone suppression test. We compared the results of normal individuals, of patients with adrenal adenomas and normal hormone profiles and with subclinical autonomous glucocorticoid hypersecretion, as well as overt cortisol excess. We found that almost all indices of the blood counts were significantly different between the patients groups. In particular, patients with adrenal non-producing adenomas already showed signs of glucocorticoid excess, including relative lymphocytopenia, lowered DHEAS, and ACTH concentrations than control individuals. We also found that the extent of lymphocytopenia correlated with the concentrations of DHEAS and ACTH, and DHEAS correlated well with ACTH. We conclude that the basal ACTH and DHEAS values along with the differential blood counts give good information on the extent of glucocorticoid excess and that silent adrenal adenomas seem to oversecrete glucocorticoids at concentrations that already alter these parameters.
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Affiliation(s)
- Eliza P Winzinger
- Division of Endocrinology and Metabolism, Rostock University Medical Center, Rostock, Germany
| | - Hana Jandikova
- Third Department of Medicine - Clinic of Endocrinology and Metabolism, Charles University First Faculty of Medicine, Prague, Czech Republic
- Division for Specific Endocrinology, University Hospital Dusseldorf, Medical Faculty HHU Dusseldorf, Dusseldorf, Germany
| | - Matthias Haase
- Division for Specific Endocrinology, University Hospital Dusseldorf, Medical Faculty HHU Dusseldorf, Dusseldorf, Germany
| | - Andreas Knauerhase
- Division of Endocrinology and Metabolism, Rostock University Medical Center, Rostock, Germany
| | - Tudor Winzinger
- Division of Endocrinology and Metabolism, Rostock University Medical Center, Rostock, Germany
| | - Matthias Schott
- Division for Specific Endocrinology, University Hospital Dusseldorf, Medical Faculty HHU Dusseldorf, Dusseldorf, Germany
| | - Holger S Willenberg
- Division of Endocrinology and Metabolism, Rostock University Medical Center, Rostock, Germany
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9
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Giovanelli L, Aresta C, Favero V, Bonomi M, Cangiano B, Eller-Vainicher C, Grassi G, Morelli V, Pugliese F, Falchetti A, Gennari L, Scillitani A, Persani L, Chiodini I. Hidden hypercortisolism: a too frequently neglected clinical condition. J Endocrinol Invest 2021; 44:1581-1596. [PMID: 33394454 DOI: 10.1007/s40618-020-01484-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/07/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE Classic Cushing's syndrome (CS) is a severe disease characterized by central obesity, hypertension, easy bruising, striae rubrae, buffalo hump, proximal myopathy and hypertricosis. However, several CS cases have also been reported with unusual or camouflaged manifestations. In recent years, several authors investigated the prevalence of "hidden hypercortisolism" (HidHyCo) among subjects affected with bone fragility, hypertension and type 2 diabetes mellitus (DM2). The prevalence of the HidHyCo is estimated to be much higher than that of classic CS. However, similarly to classic CS, HidHyCo is known to increase the risk of fractures, cardiovascular disease and mortality. METHODS We reviewed all published cases of unusual presentations of hypercortisolism and studies specifically assessing the HidHyCo prevalence in diabetic, osteoporotic and hypertensive patients. RESULTS We found 49 HidHyCo cases, in whom bone fragility, hypertension and diabetes were the presenting manifestations of an otherwise silent hypercortisolism. Amongst these cases, 34.7%, 32.7%, 6.1% and 19.0%, respectively, had bone fragility, hypertension, DM2 or hypertension plus DM2 as the sole clinical manifestations of HidHyCo. Overall, 25% of HidHyCo cases were of pituitary origin, and bone fragility was the very prevalent first manifestation among them. In population studies, it is possible to estimate that 1-4% of patients with apparent primary osteoporosis has a HidHyCo and the prevalence of this condition among diabetics ranges between 3.4 and 10%. CONCLUSION These data indicate that patients with resistant or suddenly worsening hypertension or DM2 or unexplainable bone fragility should be screened for HidHyCo using the most recently approved sensitive cut-offs.
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Affiliation(s)
- L Giovanelli
- Unit for Bone Metabolism Diseases and Diabetes and Lab of Endocrine and Metabolic Research, Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, Via Magnasco 2, 20149, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - C Aresta
- Unit for Bone Metabolism Diseases and Diabetes and Lab of Endocrine and Metabolic Research, Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, Via Magnasco 2, 20149, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - V Favero
- Unit for Bone Metabolism Diseases and Diabetes and Lab of Endocrine and Metabolic Research, Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, Via Magnasco 2, 20149, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - M Bonomi
- Unit for Bone Metabolism Diseases and Diabetes and Lab of Endocrine and Metabolic Research, Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, Via Magnasco 2, 20149, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - B Cangiano
- Unit for Bone Metabolism Diseases and Diabetes and Lab of Endocrine and Metabolic Research, Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, Via Magnasco 2, 20149, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - C Eller-Vainicher
- Unit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - G Grassi
- Unit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - V Morelli
- Unit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - F Pugliese
- Unit of Endocrinology and Diabetology "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, FG, Italy
| | - A Falchetti
- Unit for Bone Metabolism Diseases and Diabetes and Lab of Endocrine and Metabolic Research, Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, Via Magnasco 2, 20149, Milan, Italy
| | - L Gennari
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - A Scillitani
- Unit of Endocrinology and Diabetology "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, FG, Italy
| | - L Persani
- Unit for Bone Metabolism Diseases and Diabetes and Lab of Endocrine and Metabolic Research, Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, Via Magnasco 2, 20149, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - I Chiodini
- Unit for Bone Metabolism Diseases and Diabetes and Lab of Endocrine and Metabolic Research, Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, Via Magnasco 2, 20149, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
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10
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Aresta C, Soranna D, Giovanelli L, Favero V, Parazzoli C, Gennari L, Persani L, Scillitani A, Blevins LS, Brown D, Einhorn D, Pivonello R, Pantalone KM, Jørgensen JOL, Zambon A, Chiodini I. When to suspect hidden hypercortisolism in type 2 diabetes: a meta-analysis. Endocr Pract 2021; 27:1216-1224. [PMID: 34325041 DOI: 10.1016/j.eprac.2021.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Among patients with type 2 diabetes (T2D), the prevalence of hidden hypercortisolism (HidHyCo, formally called subclinical hypercortisolism or mild autonomous cortisol secretion) was estimated to be 2.2-12.1%. The aim of this study was to investigate whether the available literature helps to identify the characteristics of T2D patients more frequently associated with HidHyCo. METHODS A meta-analysis was performed using studies that assessed both the prevalence of HidHyCo in patients with T2D and the characteristics of these patients with and without HidHyCo. The DerSimonian and Laird (DSL) and the Hartung, Knapp, Sidik and Jonkman (HKSJ) methods were utilized. RESULTS Among the 18 available studies, 6 studies provided the necessary data. The association between HidHyCo and advanced T2D (based on the patients' description given in each study in presence of micro/ microvascular complications, or insulin treatment plus hypertension, or hypertension treated with ≥2 drugs), hypertension, insulin treatment and dyslipidemia was reported in 5 (2184 patients), 6 (2283 patients), 3 (1440 patients), and 3 (987 patients) studies, respectively. HidHyCo was associated with advanced T2D as assessed with both DSL (odds ratio, OR, 3.47, 95% Confidence Interval, 95%CI, 2.12-5.67) and HKSJ method (OR 3.60, 95%CI 2.03-6.41) and with the prevalence of hypertension or of insulin treatment as assessed by the DSL approach (OR 1.92, 95%CI 1.05-3.50 and OR 2.29, 95%CI 1.07-4.91, respectively), but not as assessed with HKSJ method. CONCLUSIONS Patients with advanced T2D have a higher prevalence of HidHyCo. These data inform about the selection of T2D patients for HidHyCo screening.
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Affiliation(s)
- Carmen Aresta
- Department of Endocrine and Metabolic Diseases, IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Davide Soranna
- IRCCS Istituto Auxologico Italiano, Biostatistic Unit, Milan, Italy
| | - Luca Giovanelli
- Department of Endocrine and Metabolic Diseases, IRCCS, Istituto Auxologico Italiano, Milan, Italy; Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Vittoria Favero
- Department of Endocrine and Metabolic Diseases, IRCCS, Istituto Auxologico Italiano, Milan, Italy; Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Chiara Parazzoli
- Department of Endocrine and Metabolic Diseases, IRCCS, Istituto Auxologico Italiano, Milan, Italy; Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Luigi Gennari
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Luca Persani
- Department of Endocrine and Metabolic Diseases, IRCCS, Istituto Auxologico Italiano, Milan, Italy; Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Alfredo Scillitani
- Unit of Endocrinology and Diabetology "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo (FG), Italy
| | - Lewis S Blevins
- Department of Neurosurgery, University of California San Francisco, California Center for Pituitary Disorders, San Francisco, California
| | | | - Dan Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, CA, USA
| | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Staff of UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
| | | | | | - Antonella Zambon
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy; Department of Statistics and Quantitative Methods, Università di Milano-Bicocca, Milan, Italy
| | - Iacopo Chiodini
- Department of Endocrine and Metabolic Diseases, IRCCS, Istituto Auxologico Italiano, Milan, Italy; Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy.
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11
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Campana G, Loizzo S, Fortuna A, Rimondini R, Maroccia Z, Scillitani A, Falchetti A, Spampinato SM, Persani L, Chiodini I. Early post-natal life stress induces permanent adrenocorticotropin-dependent hypercortisolism in male mice. Endocrine 2021; 73:186-195. [PMID: 33630246 DOI: 10.1007/s12020-021-02659-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/10/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE It has been hypothesized that specific early-life stress (ES) procedures on CD-1 male mice produce diabetes-like alterations due to the failure of negative feedback of glucocorticoid hormone in the pituitary. The aim of this study is to investigate the possible mechanism that leads to this pathological model, framing it in a more specific clinical condition. METHODS Metabolic and hypothalamic-pituitary-adrenal-related hormones of stressed mice (SM) have been analyzed immediately after stress procedures (21 postnatal days, PND) and after 70 days of a peaceful (unstressed) period (90 PND). These data have been compared to parameters from age-matched controls (CTR), and mice treated during ES procedures with oligonucleotide antisense for pro-opiomelanocortin (AS-POMC). RESULTS At 21 PND, SM presented an increased secretion of hypothalamic CRH and pituitary POMC-derived peptides, as well as higher plasmatic levels of ACTH and corticosterone vs. CTR. At 90 PND, SM showed hyperglycemia, with suppression of hypothalamic CRH, while pituitary and plasmatic ACTH levels, as well as plasma corticosterone, were constantly higher than in CTR. These values are accompanied by a progressive acceleration in gaining total body weight, which became significant vs. CTR at 90 PND together with a higher pituitary weight. Treatment with AS-POMC prevented all hormonal and metabolic alterations observed in SM, both at 21 and 90 PND. CONCLUSIONS These findings show that these specific ES procedures affect the negative glucocorticoid feedback in the pituitary, but not in the hypothalamus, suggesting a novel model of ACTH-dependent hypercortisolism that can be prevented by silencing the POMC gene.
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Affiliation(s)
- Gabriele Campana
- Department of Pharmacy and Biotechnology, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Stefano Loizzo
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
| | - Andrea Fortuna
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Roberto Rimondini
- Department of Medical and Clinical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Zaira Maroccia
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Alfredo Scillitani
- Endocrinology and Diabetology, Ospedale "Casa Sollievo della sofferenza" IRCCS, Viale Cappuccini 1, 71013, San Giovanni Rotondo, Foggia, Italy
| | - Alberto Falchetti
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122, Milan, Italy
| | - Santi Mario Spampinato
- Department of Pharmacy and Biotechnology, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Luca Persani
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122, Milan, Italy
- Division of Endocrine and Metabolic Diseases & Laboratory of Endocrine and Metabolic Research, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - Iacopo Chiodini
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122, Milan, Italy
- Division of Endocrine and Metabolic Diseases & Laboratory of Endocrine and Metabolic Research, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
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12
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Muraca E, Ciardullo S, Perra S, Zerbini F, Oltolini A, Cannistraci R, Bianconi E, Villa M, Pizzi M, Pizzi P, Manzoni G, Lattuada G, Perseghin G. Hypercortisolism and altered glucose homeostasis in obese patients in the pre-bariatric surgery assessment. Diabetes Metab Res Rev 2021; 37:e3389. [PMID: 32738094 DOI: 10.1002/dmrr.3389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/16/2020] [Accepted: 07/28/2020] [Indexed: 01/20/2023]
Abstract
AIMS Hypothalamus-pituitary-adrenal (HPA) axis hyperactivity was suggested to be associated with the metabolic syndrome (MS), obesity and diabetes. The aim of this study was to test whether hypercortisolism was associated with altered glucose homeostasis and insulin resistance, hypertension and dyslipidemia in a homogeneous population of obese patients. MATERIALS/METHODS In retrospective analysis of a set of data about obese patients attending the outpatient service of a single obesity centre between January 2013 and January 2020, 884 patients with BMI >30 kg/m2 were segregated in two subgroups: patients with urinary free cortisol (UFC) higher than normal (UFC+; n = 129) or within the normal range (UFC-; n = 755). RESULTS The overall prevalence of UFC+ was 14.6% and double test positivity (morning cortisol >1.8 mcg/dL following overnight dexamethasone suppression test, ODST) was detected in 1.0% of patients. Prediabetes (OR 1.74; 95%CI 1.13-2.69; p = 0.012) and diabetes (OR 2.03; 95%CI 1.21-3.42; p = 0.008) were associated with higher risk of UFC+ when analysis was adjusted for confounding variables. Conversely, hypertension and dyslipidemia were not related to UFC+. Within the individuals with normal FPG and HbA1c, those with higher estimated insulin resistance (HOMA2-IR) maintained a higher risk of UFC+ (OR 2.84, 95%CI 1.06-7.63; p = 0.039) and this relationship was weakened only when the body fat percentage was included into the model. CONCLUSIONS In obese patients, hypercortisolism was more frequent across the entire spectrum of altered glucose homeostasis including the very early stages; this relation could not be detected for the other criteria of the MS, as waist, hypertension and atherogenic dyslipidemia.
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Affiliation(s)
- Emanuele Muraca
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Stefano Ciardullo
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
- Department of Medicine and Surgery, Università degli Studi Milano Bicocca, Monza, Italy
| | - Silvia Perra
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Francesca Zerbini
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Alice Oltolini
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Rosa Cannistraci
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
- Department of Medicine and Surgery, Università degli Studi Milano Bicocca, Monza, Italy
| | - Eleonora Bianconi
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Matteo Villa
- Clinical Psychology, Policlinico di Monza, Monza, Italy
| | - Mattia Pizzi
- Centro per lo Studio, la Ricerca e la terapia dell'Obesità, Policlinico di Monza, Monza, Italy
| | - Pietro Pizzi
- Centro per lo Studio, la Ricerca e la terapia dell'Obesità, Policlinico di Monza, Monza, Italy
| | - Giuseppina Manzoni
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Guido Lattuada
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Gianluca Perseghin
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
- Department of Medicine and Surgery, Università degli Studi Milano Bicocca, Monza, Italy
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13
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Dedov II, Shestakova MV, Melnichenko GA, Mazurina NV, Andreeva EN, Bondarenko IZ, Gusova ZR, Dzgoeva FK, Eliseev MS, Ershova EV, Zhuravleva MV, Zakharchuk TA, Isakov VA, Klepikova MV, Komshilova KA, Krysanova VS, Nedogoda SV, Novikova AM, Ostroumova OD, Pereverzev AP, Rozhivanov RV, Romantsova TI, Ruyatkina LA, Salasyuk AS, Sasunova AN, Smetanina SA, Starodubova AV, Suplotova LA, Tkacheva ON, Troshina EA, Khamoshina MV, Chechelnitskaya SM, Shestakova EA, Sheremet’eva EV. INTERDISCIPLINARY CLINICAL PRACTICE GUIDELINES "MANAGEMENT OF OBESITY AND ITS COMORBIDITIES". OBESITY AND METABOLISM 2021; 18:5-99. [DOI: 10.14341/omet12714] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | - M. S. Eliseev
- Research Institute of Rheumatogy named after V.A. Nasonova
| | | | | | | | - V. A. Isakov
- Federal Research Center of Nutrition, Biotechnology and Food Safety
| | - M. V. Klepikova
- Russian Medical Academy of Continuous Professional Education
| | | | | | | | - A. M. Novikova
- Research Institute of Rheumatogy named after V.A. Nasonova
| | - O. D. Ostroumova
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - A. P. Pereverzev
- Russian National Research Medical University named after N.I. Pirogov
| | | | | | | | | | - A. N. Sasunova
- Federal Research Center of Nutrition, Biotechnology and Food Safety
| | | | | | | | - O. N. Tkacheva
- Russian National Research Medical University named after N.I. Pirogov
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14
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Schernthaner-Reiter MH, Wolf P, Vila G, Luger A. The Interaction of Insulin and Pituitary Hormone Syndromes. Front Endocrinol (Lausanne) 2021; 12:626427. [PMID: 33995272 PMCID: PMC8113952 DOI: 10.3389/fendo.2021.626427] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/06/2021] [Indexed: 12/21/2022] Open
Abstract
Pituitary hormone axes modulate glucose metabolism and exert direct or indirect effects on insulin secretion and function. Cortisol and growth hormone are potent insulin-antagonistic hormones. Therefore impaired glucose tolerance, elevated fasting glucose concentrations and diabetes mellitus are frequent in Cushing's disease and acromegaly. Also prolactinomas, growth hormone (GH) deficiency, hypogonadism and hypothyroidism might be associated with impaired glucose homeostasis but usually to a lesser extent. Therefore glucose metabolism needs to be closely monitored and treated in patients with pituitary adenomas. Correction of the pituitary dysfunction is frequently followed by improvement of glucose homeostasis.
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15
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Panagiotou C, Lambadiari V, Maratou E, Geromeriati C, Artemiadis A, Dimitriadis G, Moutsatsou P. Insufficient glucocorticoid receptor signaling and flattened salivary cortisol profile are associated with metabolic and inflammatory indices in type 2 diabetes. J Endocrinol Invest 2021; 44:37-48. [PMID: 32394161 DOI: 10.1007/s40618-020-01260-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/15/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Impaired negative feedback and hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis characterizes type 2 diabetes mellitus (T2DM). The glucocorticoid receptor (GR) is a key mediator of HPA axis negative feedback; however, its role in linking hypercortisolemia and T2DM-associated hyperglycemia, hyperlipidemia and inflammation is not yet known. METHODS In peripheral mononuclear cells (PBMC) from 31 T2DM patients and 24 healthy controls, we measured various GR-signaling parameters such as phosphorylated GR (pGR-S211), GRα/GRβ gene expression and GC-sensitivity [using the basal and dexamethasone (DEX)-induced leucine zipper (GILZ) and FK506 binding-protein (FKBP5) mRNA levels as well as the basal interleukin (IL)-1β protein levels]. Diurnal salivary cortisol curve parameters such as the cortisol awaking response (CAR) and area under the curve (AUCtotal and AUCi) as well as inflammatory and metabolic indices were also determined. RESULTS T2DM patients exhibited diminished pGR-S211 protein content, increased GRβ, decreased basal GILZ and FKBP5 mRNA levels and increased IL-1β levels. Flattened DEX-induced GILZ and FKBP5 response curves and a flattened salivary cortisol profile characterized T2DM patients. Significant associations of GR measures and saliva cortisol curve parameters with biochemical and clinical characteristics were found. CONCLUSION Our novel data implicate an insufficient GR signaling in PBMCs in T2DM patients and HPA axis dysfunction. The significant associations of GR-signaling parameters with inflammatory and metabolic indices implicate that GR may be the critical link between HPA axis dysfunction, hypercortisolemia and diabetes-associated metabolic disturbances. Our findings provide significant insights into the contribution of GR-mediated mechanisms in T2DM aetiopathology and therapy.
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Affiliation(s)
- C Panagiotou
- Department of Clinical Biochemistry, National and Kapodistrian University of Athens, School of Medicine, University General Hospital Attikon, Rimini 1, Haidari, 12462, Athens, Greece
| | - V Lambadiari
- Second Department of Internal Medicine and Research Institute, University General Hospital Attikon, Haidari, Greece
| | - E Maratou
- Department of Clinical Biochemistry, National and Kapodistrian University of Athens, School of Medicine, University General Hospital Attikon, Rimini 1, Haidari, 12462, Athens, Greece
| | - C Geromeriati
- Department of Clinical Biochemistry, National and Kapodistrian University of Athens, School of Medicine, University General Hospital Attikon, Rimini 1, Haidari, 12462, Athens, Greece
| | - A Artemiadis
- Medical School, University of Cyprus, Nicosia, Cyprus
| | - G Dimitriadis
- Second Department of Internal Medicine and Research Institute, University General Hospital Attikon, Haidari, Greece
| | - P Moutsatsou
- Department of Clinical Biochemistry, National and Kapodistrian University of Athens, School of Medicine, University General Hospital Attikon, Rimini 1, Haidari, 12462, Athens, Greece.
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16
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Stachowska B, Kuliczkowska-Płaksej J, Kałużny M, Grzegrzółka J, Jończyk M, Bolanowski M. Etiology, baseline clinical profile and comorbidities of patients with Cushing's syndrome at a single endocrinological center. Endocrine 2020; 70:616-628. [PMID: 32880849 PMCID: PMC7674323 DOI: 10.1007/s12020-020-02468-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/19/2020] [Indexed: 12/02/2022]
Abstract
PURPOSE The aim of this study was to compare phenotype of patients with pituitary, adrenal and ectopic CS and identify the differences regarding biochemical parameters, clinical presentations, and comorbidities in CS patients who were diagnosed at the single endocrinological center in Wroclaw. METHODS The study population involved 64 patients with CS (53 women and 11 men) diagnosed in Department of Endocrinology, Diabetes and Isotope Therapy in 2000-2018. Patients were divided into three etiologic groups: pituitary dependent-CS (P-CS) (64%), adrenal dependent CS (A-CS) (25%), and CS from an ectopic source (E-CS) (11%). RESULTS Percentage of men in the A-CS group was significantly higher than in the other etiologic groups. ACTH, UFC, and cortisol in DST were significantly higher in E-CS group compare to P-CS and A-CS (p < 0.05). Mean potassium level in E-CS group was significantly lower than in P-CS and A-CS (p < 0.05). Median of time elapsed to diagnosis was significantly lower in the E-CS group compared with either the P-CS and the A-CS group (p < 0.01). The most frequently symptoms in CS patients were skin alterations (82.8%), weight gain (81.2%), and hypertension (81.2%). CONCLUSIONS The epidemiology of CS is changing toward a growing proportion of A-CS. All patients with E-CS presented a profound hypokalemia. Salient hypokalemia could be a biochemical marker more suggestive for E-CS rather than P-CS. The incidence of diabetes is more frequent in E-CS group than in P-CS and A-CS groups.
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Affiliation(s)
- Barbara Stachowska
- Department and Clinic of Endocrinology, Diabetes, and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland.
| | - Justyna Kuliczkowska-Płaksej
- Department and Clinic of Endocrinology, Diabetes, and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Marcin Kałużny
- Department and Clinic of Endocrinology, Diabetes, and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Jędrzej Grzegrzółka
- Department and Clinic of Endocrinology, Diabetes, and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Maja Jończyk
- Department and Clinic of Endocrinology, Diabetes, and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Marek Bolanowski
- Department and Clinic of Endocrinology, Diabetes, and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland
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Assessment of 1 mg Dexamethasone Suppression Test in Patients with Obesity Before Bariatric Surgery. Obes Surg 2020; 30:4981-4985. [PMID: 32803707 DOI: 10.1007/s11695-020-04865-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/11/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aims to examine the prevalence of Cushing's syndrome (CS) in class 3 obese patients before bariatric surgery. MATERIALS AND METHODS The data of 1037 class 3 obese patients admitted to the endocrinology outpatient clinic for endocrinological evaluation before bariatric surgery between 2012 and 2019were reviewed retrospectively. One milligram dexamethasone suppression test (DST) was used for the evaluation of hypercortisolism in all cases and cutoff accepted as 1.8 μg/dL. RESULTS The mean body mass index (BMI) was 48 ± 8.9 kg/m2 and age was 42 ± 10 years with female preponderance (F/M: 799/238] being observed in this cohort. Insufficient cortisol suppression was found in 40 patients; confirmed hypercortisolemia was detected in 8 patients. The prevalence of pathologic DST was 3.85% and 0.77% in confirmed hypercortisolism. The specificity for 1-mg DST with the cutoff 1.8 μg/dL was calculated as 96.8%. CONCLUSION Hypercortisolism prevalence was found to be low, and 1 mg DST is a sufficient test for the screening of CS in class 3 obese patients evaluated before bariatric surgery.
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18
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Glyn TC, Ho MWJ, Lambert AP, Thomas JDJ, Douek IF, Andrews RC, King RJ. Patients with morbid obesity should not be routinely screened for Cushing's syndrome: Results of retrospective study of patients attending a specialist weight management service. Clin Obes 2020; 10:e12358. [PMID: 31994330 DOI: 10.1111/cob.12358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 11/30/2022]
Abstract
Cushing's syndrome (CS) is a rare condition which results in multi-system involvement and can lead to significant morbidity and mortality. Screening for CS in patients with obesity has been suggested to identify undiagnosed or occult cases. This study was performed to determine whether CS screening is indicated in a tier 3 weight management centre in the UK. A retrospective review of all patients referred to the weight management service between 2013 and 2016 inclusive was undertaken. A final cohort of 569 patients was obtained. Clinic letters and laboratory databases were used to obtain demographic information, patient characteristics and biochemical results. A total of 387 patients were screened using the 1 mg overnight dexamethasone suppression test (ODST) and 182 patients were screened with two 24-hour urinary free cortisol (UFC) collections. A total of 27 patients had an initial abnormal result, of which 16 underwent further testing and had normal results. Six were reviewed and did not demonstrate any clinical features of CS. Five did not attend their clinic appointments but there were neither concerning features within their referrals, nor subsequent diagnoses of CS made. No patients from this cohort were diagnosed with CS. This study does not support routine CS screening of patients affected by severe obesity referred to a specialist tier 3 weight management service. Clinical assessment should be undertaken first and further investigations performed only if deemed necessary.
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Affiliation(s)
- Tessa Carlin Glyn
- Taunton Weight Management Service, Musgrove Park Hospital, Taunton, UK
| | - May Wai-Jing Ho
- Taunton Weight Management Service, Musgrove Park Hospital, Taunton, UK
| | | | | | | | | | - Rhodri James King
- Taunton Weight Management Service, Musgrove Park Hospital, Taunton, UK
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Solari D, Pivonello R, Caggiano C, Guadagno E, Chiaramonte C, Miccoli G, Cavallo LM, Del Basso De Caro M, Colao A, Cappabianca P. Pituitary Adenomas: What Are the Key Features? What Are the Current Treatments? Where Is the Future Taking Us? World Neurosurg 2020; 127:695-709. [PMID: 31266132 DOI: 10.1016/j.wneu.2019.03.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/05/2019] [Indexed: 12/18/2022]
Abstract
Pituitary tumors are a heterogeneous group of lesions (usually benign) and proper understanding of the anatomy, physiology, and pathology of the hypothalamic/pituitary region is essential to make an accurate diagnosis and define the essential treatment options (i.e., surgery, medical therapies, and radiotherapy, alone or in combination). Surgery is the primary treatment for acromegaly, Cushing disease, thyroid-stimulating hormone-secreting adenomas, resistant prolactinomas, and nonfunctioning pituitary adenomas causing mass effect. Medical and radiation therapy are reserved in cases in which surgery is not possible or does not provide a complete cure. In the last decades, tremendous innovations (i.e., targeted drugs and refined surgical tools and techniques) have expanded the treatment strategies for pituitary adenomas. We herein report the current indications for and depiction of the surgical techniques in pituitary surgery, review current medical treatments, and provide a glimpse of future possibilities.
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Affiliation(s)
- Domenico Solari
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy.
| | - Rosario Pivonello
- Division of Endocrinology, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Chiara Caggiano
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Elia Guadagno
- Department of Advanced Biomedical Sciences, Section of Pathology, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Carmela Chiaramonte
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Giovanni Miccoli
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Luigi M Cavallo
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Marialaura Del Basso De Caro
- Department of Advanced Biomedical Sciences, Section of Pathology, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Annamaria Colao
- Division of Endocrinology, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Paolo Cappabianca
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
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20
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Scaroni C, Albiger NM, Palmieri S, Iacuaniello D, Graziadio C, Damiani L, Zilio M, Stigliano A, Colao A, Pivonello R. Approach to patients with pseudo-Cushing's states. Endocr Connect 2020; 9:R1-R13. [PMID: 31846432 PMCID: PMC6993268 DOI: 10.1530/ec-19-0435] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/16/2019] [Indexed: 12/19/2022]
Abstract
The distinction between pseudo-Cushing's states (PCS) and Cushing's syndrome (CS) poses a significant clinical challenge even for expert endocrinologists. A patient's clinical history can sometimes help to distinguish between them (as in the case of alcoholic individuals), but the overlap in clinical and laboratory findings makes it difficult to arrive at a definitive diagnosis. We aim to describe the most common situations that can give rise to a condition resembling overt endogenous hypercortisolism and try to answer questions that physicians often face in clinical practice. It is important to know the relative prevalence of these different situations, bearing in mind that most of the conditions generating PCS are relatively common (such as metabolic syndrome and polycystic ovary syndrome), while CS is rare in the general population. Physicians should consider CS in the presence of additional features. Appropriate treatment of underlying conditions is essential as it can reverse the hormonal abnormalities associated with PCS. Close surveillance and a thorough assessment of a patient's hormone status will ultimately orient the diagnosis and treatment options over time.
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Affiliation(s)
- Carla Scaroni
- Dipartimento di Medicina, U.O.C. Endocrinologia, Università di Padova, Padova, Italy
- Correspondence should be addressed to C Scaroni:
| | - Nora M Albiger
- Dipartimento di Medicina, U.O.C. Endocrinologia, Università di Padova, Padova, Italy
| | - Serena Palmieri
- Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Iacuaniello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Napoli, Italy
| | - Chiara Graziadio
- Department of Experimental Medicine, University La Sapienza, Rome, Italy
| | - Luca Damiani
- Department of Medical Sciences, Endocrinology and Internal Medicine Section, University of Ferrara, Ferrara, Italy
| | - Marialuisa Zilio
- Dipartimento di Medicina, U.O.C. Endocrinologia, Università di Padova, Padova, Italy
| | - Antonio Stigliano
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University La Sapienza, Rome, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Napoli, Italy
| | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Napoli, Italy
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21
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Surgical and radiosurgical treatment strategies for Cushing’s disease. J Neurooncol 2019; 145:403-413. [DOI: 10.1007/s11060-019-03325-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/26/2019] [Indexed: 12/11/2022]
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22
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Lin DC, Tsai PS, Lin YC. Midnight salivary cortisol for the diagnosis of Cushing's syndrome in a Chinese population. Singapore Med J 2018; 60:359-363. [PMID: 30488082 DOI: 10.11622/smedj.2018154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Cushing's syndrome is defined as chronic excess free cortisol in circulation. According to recent studies, midnight salivary cortisol is an accurate and non-stress method for screening and diagnosing Cushing's syndrome. However, there is limited data on midnight salivary cortisol for diagnosing Cushing's syndrome in the Chinese population. METHODS Among 61 suspected Chinese patients, 48 patients were confirmed to have Cushing's syndrome. We evaluated the midnight salivary cortisol, midnight serum cortisol and 24-hour urine free cortisol excretion for diagnosis. Midnight salivary cortisol was collected from 21 healthy volunteers for control purposes. RESULTS In the patient group, mean urine free cortisol excretion and midnight salivary cortisol levels were 296.50 ± 47.99 µg/day and 10.18 ± 1.29 ng/mL, respectively. Among the control group and normal participants, mean midnight salivary cortisol level was 0.53 ± 0.13 ng/mL and 0.50 ± 0.12 ng/mL, respectively. The cut-off value for midnight salivary cortisol was 1.7 ng/mL for diagnosing Cushing's syndrome, with a sensitivity of 98% and specificity of 100%. The diagnostic performance of midnight salivary cortisol (area under the curve [AUC] = 0.99) was superior to that of urine free cortisol (AUC = 0.89). CONCLUSION Our study confirmed the good diagnostic performance of midnight salivary cortisol for diagnosing Cushing's syndrome in a Chinese population. Correlation between midnight salivary cortisol and either urine free cortisol or midnight serum cortisol was good. Midnight salivary cortisol is a convenient and precise tool for diagnosing Cushing's syndrome and can be the screening test of choice for Chinese populations.
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Affiliation(s)
- Dao-Chen Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei-Shan Tsai
- Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Yi-Chun Lin
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
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Reimondo G, Puglisi S, Pia A, Terzolo M. Autonomous hypercortisolism: definition and clinical implications. MINERVA ENDOCRINOL 2018; 44:33-42. [PMID: 29963828 DOI: 10.23736/s0391-1977.18.02884-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In current practice, an adrenal adenoma usually comes as an unexpected byproduct of an imaging study performed for unrelated reasons, without any prior suspect of adrenal disease. Therefore, these tumors currently represent a public health challenge because they are increasingly recognized due to the widespread use of high-resolution cross-sectional imaging for diagnostic purposes. In radiology series, the prevalence of adrenal adenomas increases steeply with age, from around 3% below the age of 50 years up to 10% in the ageing population. These tumors may have clinical relevance because they are able to secrete cortisol autonomously, independently from the pituitary control, in up to 20-30% of patients. In most of the cases the resulting cortisol excess is insufficient to produce a typical Cushing phenotype but may have clinical consequences, such as hypertension, diabetes, obesity, dyslipidemia and osteoporosis. Despite some controversy on the most effective diagnostic algorithm to define this subtle hypercortisolism, there is mounting evidence that a simple approach by using the 1-mg overnight dexamethasone suppression test (DST) may stratify patients for their cardiovascular risk. Cross-sectional, retrospective studies showed that patients with increasingly higher cortisol following DST have an adverse cardiovascular risk profile and are at increased risk of death. Therefore, also a subtle autonomous cortisol excess is associated with increased morbidity and mortality, mainly of cardiovascular origin.
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Affiliation(s)
- Giuseppe Reimondo
- Unit of Internal Medicine and Endocrinology, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Turin, Orbassano, Turin, Italy -
| | - Soraya Puglisi
- Unit of Internal Medicine and Endocrinology, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Turin, Orbassano, Turin, Italy
| | - Anna Pia
- Unit of Internal Medicine and Endocrinology, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Turin, Orbassano, Turin, Italy
| | - Massimo Terzolo
- Unit of Internal Medicine and Endocrinology, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Turin, Orbassano, Turin, Italy
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Secondary Diabetes Mellitus in Patients with Endogenous Cushing’s Syndrome - Clinical Characteristics at Diagnosis. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2018. [DOI: 10.2478/rjdnmd-2018-0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Background and aims. Endogenous Cushing’s syndrome is a rare disease associated with severe morbidity and increased mortality if untreated. Diabetes mellitus is a frequent initial complaint of these patients. Our aim was to investigate the clinical characteristics at the time of diagnosis in a cohort of patients with endogenous Cushing’s syndrome (CS).
Material and methods. A retrospective analysis of the presentation of 68 cases diagnosed with endogenous Cushing’s syndrome followed-up in our institution was performed.
Results: There were 57 women and 11 men, aged 18-74 years (mean 45.57±14.2). 38 had Cushing’s disease (CD) while 30 had adrenal CS. The most frequent signs/symptoms leading to the initial consultation and diagnostic suspicion were central obesity (55 cases, 80.88%), purple striae (28 cases, 41.1%), secondary arterial hypertension (27 cases, 39.7%), secondary diabetes mellitus (24 cases, 35.29%), hirsutism in 23/55 women (41.81%), hypogonadism in 23 cases (33.82%), proximal myopathy in 17 cases (25%), edema (10 cases, 14.7%). 13 cases (19.11%) also had secondary osteoporosis (diagnosed by dual energy x-ray absorptiometry - DXA osteodensitometry). Among the two diagnostic groups there were several differences. Proximal myopathy, secondary hypertension and diabetes mellitus were all more frequent in cases with adrenal Cushing compared to those with CD. (p= 0.011, 0.006 and 0.024, respectively). This did not reflect more severe hypercortisolism in adrenal CS, as the hormonal values were similar in the two groups.
Conclusion: If associated with certain clinical signs, some nonspecific (central obesity, edema, arterial hypertension), other more suggestive of CS (purple striae, proximal myopathy) diabetes mellitus could be the initial sign of this severe condition.
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25
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Mészáros K, Karvaly G, Márta Z, Magda B, Tőke J, Szücs N, Tóth M, Rácz K, Patócs A. Diagnostic performance of a newly developed salivary cortisol and cortisone measurement using an LC-MS/MS method with simple and rapid sample preparation. J Endocrinol Invest 2018; 41:315-323. [PMID: 28815484 DOI: 10.1007/s40618-017-0743-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 08/07/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Late-night salivary cortisol level is one of the first-line tests recommended by the Endocrine Society for the diagnosis of endogenous hypercortisolism. Most routine laboratories measure cortisol levels using immunoassay tests which fail to determine low cortisol levels accurately due to the numerous interfering substances. A liquid chromatography-tandem mass spectrometry (LC-MS/MS) method with simple and rapid sample preparation was developed for the simultaneous measurement of cortisol and cortisone and its performance in the diagnosis of endogenous hypercortisolism was evaluated. METHODS 324 late-night saliva samples were analyzed from which 272 samples were derived from patients with a suspected diagnosis of endogenous hypercortisolism. Salivary cortisol levels were assayed using an electrochemiluminescent immunoassay (ECLIA, Cortisol II, Roche), and simultaneous measurement of cortisol and cortisone was performed using an LC-MS/MS method. RESULTS A strong correlation between cortisol results measured using ECLIA and LC-MS/MS (r 2 = 0.892) was demonstrated. Receiver operating characteristics (ROC) analysis showed good diagnostic performance of cortisol and cortisone levels assayed using LC-MS/MS method and for cortisol measured using ECLIA. CONCLUSIONS Late-night salivary cortisol and cortisone are useful parameters for the diagnosis of hypercortisolism. Using samples obtained from patients where the diagnosis of hypercortisolism is extremely challenging cut-off values for midnight salivary cortisol and cortisone measured by LC-MS/MS method were established.
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Affiliation(s)
- K Mészáros
- Department of Laboratory Medicine, MTA-SE Lendulet Research Group, Hungarian Academy of Sciences, Semmelweis University, 46. Szentkiralyi str, Budapest, 1088, Hungary
- "Lendület" Hereditary Endocrine Tumours Research Group, HAS-SE, Budapest, Hungary
- Bionics Innovation Center, Budapest, Hungary
| | - G Karvaly
- Department of Laboratory Medicine, MTA-SE Lendulet Research Group, Hungarian Academy of Sciences, Semmelweis University, 46. Szentkiralyi str, Budapest, 1088, Hungary
- Bionics Innovation Center, Budapest, Hungary
| | - Z Márta
- MS Metabolomics Research Group, HAS, Budapest, Hungary
| | - B Magda
- MS Metabolomics Research Group, HAS, Budapest, Hungary
| | - J Tőke
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - N Szücs
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - M Tóth
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - K Rácz
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
- Molecular Medicine Research Group, HAS-SE, Budapest, Hungary
| | - A Patócs
- Department of Laboratory Medicine, MTA-SE Lendulet Research Group, Hungarian Academy of Sciences, Semmelweis University, 46. Szentkiralyi str, Budapest, 1088, Hungary.
- "Lendület" Hereditary Endocrine Tumours Research Group, HAS-SE, Budapest, Hungary.
- Bionics Innovation Center, Budapest, Hungary.
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Delivanis DA, Iñiguez-Ariza NM, Zeb MH, Moynagh MR, Takahashi N, McKenzie TJ, Thomas MA, Gogos C, Young WF, Bancos I, Kyriazopoulou V. Impact of hypercortisolism on skeletal muscle mass and adipose tissue mass in patients with adrenal adenomas. Clin Endocrinol (Oxf) 2018; 88:209-216. [PMID: 29115003 DOI: 10.1111/cen.13512] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 10/31/2017] [Accepted: 11/02/2017] [Indexed: 01/25/2023]
Abstract
CONTEXT Abdominal visceral adiposity and central sarcopenia are markers of increased cardiovascular risk and mortality. OBJECTIVE To assess whether central sarcopenia and adiposity can serve as a marker of disease severity in patients with adrenal adenomas and glucocorticoid secretory autonomy. DESIGN Retrospective cohort study. PATIENTS Twenty-five patients with overt Cushing's syndrome (CS), 48 patients with mild autonomous cortisol excess (MACE) and 32 patients with a nonfunctioning adrenal tumour (NFAT) were included. METHODS Medical records were reviewed, and body composition measurements (visceral fat [VAT], subcutaneous fat [SAT], visceral/total fat [V/T], visceral/subcutaneous [V/S] and total abdominal muscle mass) were calculated based on abdominal computed tomography (CT). RESULTS In patients with overt CS, when compared to patients with NFAT, the V/T fat and the V/S ratio were increased by 0.08 (P < .001) and by 0.3 (P < .001); however, these measurements were decreased by 0.04 (P = .007) and 0.2 (P = .01), respectively, in patients with MACE. Total muscle mass was decreased by -10 cm2 (P = .02) in patients with overt CS compared to patients with NFAT. Correlation with morning serum cortisol concentrations after dexamethasone suppression testing revealed that for every 28 nmol/L cortisol increase there was a 0.008 increase in V/T (P < .001), 0.02 increase in the V/S fat ratio (P < .001) and a 1.2 cm2 decrease in mean total muscle mass (P = .002). CONCLUSIONS The severity of hypercortisolism was correlated with lower muscle mass and higher visceral adiposity. These CT-based markers may allow for a more reliable and objective assessment of glucocorticoid-related disease severity in patients with adrenal adenomas.
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Affiliation(s)
- Danae A Delivanis
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Nicole M Iñiguez-Ariza
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Melinda A Thomas
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Charalambos Gogos
- Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - William F Young
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
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An approach to screening for Cushing's syndrome in non-specialized health care settings. ACTA ACUST UNITED AC 2017; 64:407-408. [PMID: 28895535 DOI: 10.1016/j.endinu.2017.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 04/23/2017] [Indexed: 11/23/2022]
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Abstract
Cushing syndrome (CS) is caused by chronic exposure to excess glucocorticoids. Early recognition and treatment of hypercortisolemia can lead to decreased morbidity and mortality. The diagnosis of CS and thereafter, establishing the cause can often be difficult, especially in patients with mild and cyclic hypercortisolism. Surgical excision of the cause of excess glucocorticoids is the optimal treatment for CS. Medical therapy (steroidogenesis inhibitors, medications that decrease adrenocorticotropic hormone [ACTH] levels or glucocorticoid antagonists) and pituitary radiotherapy may be needed as adjunctive treatment modalities in patients with residual, recurrent or metastatic disease, in preparation for surgery, or when surgery is contraindicated. A multidisciplinary team approach, individualized treatment plan and long-term follow-up are important for optimal management of hypercortisolemia and the comorbidities associated with CS. ABBREVIATIONS ACTH = adrenocorticotropic hormone; BIPSS = bilateral inferior petrosal sinus sampling; CBG = corticosteroid-binding globulin; CD = Cushing disease; CRH = corticotropin-releasing hormone; CS = Cushing syndrome; Dex = dexamethasone; DST = dexamethasone suppression test; EAS = ectopic ACTH syndrome; FDA = U.S. Food & Drug Administration; HDDST = high-dose DST; IPS/P = inferior petrosal sinus to peripheral; MRI = magnetic resonance imaging; NET = neuroendocrine tumor; PET = positron emission tomography; UFC = urinary free cortisol.
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Scaroni C, Zilio M, Foti M, Boscaro M. Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management. Endocr Rev 2017; 38:189-219. [PMID: 28368467 DOI: 10.1210/er.2016-1105] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 03/15/2017] [Indexed: 12/13/2022]
Abstract
An impaired glucose metabolism, which often leads to the onset of diabetes mellitus (DM), is a common complication of chronic exposure to exogenous and endogenous glucocorticoid (GC) excess and plays an important part in contributing to morbidity and mortality in patients with Cushing syndrome (CS). This article reviews the pathogenesis, epidemiology, diagnosis, and management of changes in glucose metabolism associated with hypercortisolism, addressing both the pathophysiological aspects and the clinical and therapeutic implications. Chronic hypercortisolism may have pleiotropic effects on all major peripheral tissues governing glucose homeostasis. Adding further complexity, both genomic and nongenomic mechanisms are directly induced by GCs in a context-specific and cell-/organ-dependent manner. In this paper, the discussion focuses on established and potential pathologic molecular mechanisms that are induced by chronically excessive circulating levels of GCs and affect glucose homeostasis in various tissues. The management of patients with CS and DM includes treating their hyperglycemia and correcting their GC excess. The effects on glycemic control of various medical therapies for CS are reviewed in this paper. The association between DM and subclinical CS and the role of screening for CS in diabetic patients are also discussed.
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Affiliation(s)
- Carla Scaroni
- Endocrinology Unit, Department of Medicine, DIMED, University of Padova, Via Ospedale 105, 35128 Padua, Italy
| | - Marialuisa Zilio
- Endocrinology Unit, Department of Medicine, DIMED, University of Padova, Via Ospedale 105, 35128 Padua, Italy
| | - Michelangelo Foti
- Department of Cell Physiology & Metabolism, Centre Médical Universitaire, 1 Rue Michel Servet, 1211 Genèva, Switzerland
| | - Marco Boscaro
- Endocrinology Unit, Department of Medicine, DIMED, University of Padova, Via Ospedale 105, 35128 Padua, Italy
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Findling JW, Raff H. DIAGNOSIS OF ENDOCRINE DISEASE: Differentiation of pathologic/neoplastic hypercortisolism (Cushing's syndrome) from physiologic/non-neoplastic hypercortisolism (formerly known as pseudo-Cushing's syndrome). Eur J Endocrinol 2017; 176:R205-R216. [PMID: 28179447 DOI: 10.1530/eje-16-0946] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/20/2017] [Accepted: 02/06/2017] [Indexed: 12/30/2022]
Abstract
Endogenous hypercortisolism (Cushing's syndrome) usually implies the presence of a pathologic condition caused by either an ACTH-secreting neoplasm or autonomous cortisol secretion from a benign or malignant adrenal neoplasm. However, sustained or intermittent hypercortisolism may also accompany many medical disorders that stimulate physiologic/non-neoplastic activation of the HPA axis (formerly known as pseudo-Cushing's syndrome); these two entities may share indistinguishable clinical and biochemical features. A thorough history and physical examination is often the best (and sometimes only) way to exclude pathologic/neoplastic hypercortisolism. The presence of alcoholism, renal failure, poorly controlled diabetes and severe neuropsychiatric disorders should always raise suspicion that the presence of hypercortisolism may be related to physiologic/non-neoplastic Cushing's syndrome. As late-night salivary cortisol and low-dose dexamethasone suppression have good sensitivity and negative predictive value, normal studies exclude Cushing's syndrome of any form. However, these tests have imperfect specificity and additional testing over time with clinical follow-up is often needed. When there is persistent diagnostic uncertainty, secondary tests such as the DDAVP stimulation test and the dexamethasone-CRH test may provide evidence for the presence or absence of an ACTH-secreting tumor. This review will define and characterize the numerous causes of physiologic/non-neoplastic hypercortisolism and provide a rational clinical and biochemical approach to distinguish it from pathologic/neoplastic hypercortisolism (true Cushing's syndrome).
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Affiliation(s)
- James W Findling
- Endocrinology Center and ClinicsMedical College of Wisconsin, Menomonee Falls, Wisconsin, USA
| | - Hershel Raff
- Departments of MedicineSurgery, and Physiology, Medical College of Wisconsin and Endocrine Research Laboratory, Aurora St Luke's Medical Center, Aurora Research Institute, Milwaukee, Wisconsin, USA
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31
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Hirsch D, Tsvetov G, Manisterski Y, Aviran-Barak N, Nadler V, Alboim S, Kopel V. Incidence of Cushing's syndrome in patients with significant hypercortisoluria. Eur J Endocrinol 2017; 176:41-48. [PMID: 27737902 DOI: 10.1530/eje-16-0631] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/27/2016] [Accepted: 10/13/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the incidence of Cushing's syndrome (CS) in patients with significant hypercortisoluria and the performance of urinary free cortisol (UFC) screening. DESIGN Retrospective file review. METHODS The computerized database of a publicly funded health maintenance organization (HMO) in Israel was searched for all patients who underwent 24-h UFC testing in 2005-2014 with a result of more than twice the upper limit of normal (ULN). The patients' medical files were reviewed for a subsequent diagnosis of CS by an expert endocrinologist. Findings were evaluated for patterns in CS diagnosis and UFC testing over time. RESULTS Of 41 183 individuals tested, 510 (1.2%) had UFC >2× ULN (214 >3× ULN). Eighty-five (16.7%) individuals were diagnosed with CS (63 female and mean age 47.2 ± 15.1 years), mainly Cushing's disease (55.3%) or adrenal Cushing's syndrome (37.6%). The number of UFC tests increased steadily, from 1804 in 2005 to 6464 in 2014; yet, the resultant detection rate of CS remained generally stable. The calculated incidence of CS in the general HMO-insured population based only on the patients identified in the present cohort was 4.5 new cases/million/year (median 4.9/million/year, range 1.7-5.9/million/year), which was also relatively stable. The most common reason for referral for UFC screening was obesity. Of the 148 patients before bariatric surgery with UFC >2× ULN, 2 were diagnosed with CS. CONCLUSIONS The incidence of CS is higher than previously suggested. The consistently increasing number of UFC tests being performed has not been accompanied by a similar increase in CS detection rate. The expected yield of routine UFC testing before bariatric surgery is low.
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Affiliation(s)
- Dania Hirsch
- Institute of EndocrinologyRabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of MedicineTel Aviv University, Tel Aviv, Israel
- Maccabi Health Care Services
| | - Gloria Tsvetov
- Institute of EndocrinologyRabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of MedicineTel Aviv University, Tel Aviv, Israel
- Maccabi Health Care Services
| | - Yossi Manisterski
- Sackler Faculty of MedicineTel Aviv University, Tel Aviv, Israel
- Maccabi Health Care Services
| | | | - Varda Nadler
- Central LaboratoryMaccabi Healthcare Services, Rehovot, Israel
| | - Sandra Alboim
- Central LaboratoryMaccabi Healthcare Services, Rehovot, Israel
| | - Vered Kopel
- Central LaboratoryMaccabi Healthcare Services, Rehovot, Israel
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32
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Steffensen C, Pereira AM, Dekkers OM, Jørgensen JOL. DIAGNOSIS OF ENDOCRINE DISEASE: Prevalence of hypercortisolism in type 2 diabetes patients: a systematic review and meta-analysis. Eur J Endocrinol 2016; 175:R247-R253. [PMID: 27354298 DOI: 10.1530/eje-16-0434] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 06/08/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 2 diabetes (T2D) and Cushing's syndrome (CS) share clinical characteristics, and several small studies have recorded a high prevalence of hypercortisolism in T2D, which could have therapeutic implications. We aimed to assess the prevalence of endogenous hypercortisolism in T2D patients. DESIGN Systematic review and meta-analysis of the literature. METHODS A search was performed in SCOPUS, MEDLINE, and EMBASE for original articles assessing the prevalence of endogenous hypercortisolism and CS in T2D. Data were pooled in a random-effect logistic regression model and reported with 95% confidence intervals (95% CI). RESULTS Fourteen articles were included, with a total of 2827 T2D patients. The pooled prevalence of hypercortisolism and CS was 3.4% (95% CI: 1.5-5.9) and 1.4% (95 CI: 0.4-2.9) respectively. The prevalence did not differ between studies of unselected patients and patients selected based on the presence of metabolic features such as obesity or poor glycemic control (P = 0.41 from meta-regression). Imaging in patients with hypercortisolism (n = 102) revealed adrenal tumors and pituitary tumors in 52 and 14% respectively. CONCLUSIONS Endogenous hypercortisolism is a relatively frequent finding in T2D, which may have therapeutic implications.
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Affiliation(s)
- Charlotte Steffensen
- Department of Endocrinology and Internal MedicineAarhus University Hospital, Aarhus, Denmark
| | - Alberto M Pereira
- Department of MedicineSection Endocrinology, Leiden University Medical Center, Leiden,
The Netherlands
| | - Olaf M Dekkers
- Department of MedicineSection Endocrinology, Leiden University Medical Center, Leiden,
The Netherlands Department of Clinical EpidemiologyAarhus University Hospital, Aarhus, Denmark Department of Clinical EpidemiologyLeiden University Medical Center, Leiden, The Netherlands
| | - Jens Otto L Jørgensen
- Department of Endocrinology and Internal MedicineAarhus University Hospital, Aarhus, Denmark
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León-Justel A, Madrazo-Atutxa A, Alvarez-Rios AI, Infantes-Fontán R, Garcia-Arnés JA, Lillo-Muñoz JA, Aulinas A, Urgell-Rull E, Boronat M, Sánchez-de-Abajo A, Fajardo-Montañana C, Ortuño-Alonso M, Salinas-Vert I, Granada ML, Cano DA, Leal-Cerro A. A Probabilistic Model for Cushing's Syndrome Screening in At-Risk Populations: A Prospective Multicenter Study. J Clin Endocrinol Metab 2016; 101:3747-3754. [PMID: 27490917 DOI: 10.1210/jc.2016-1673] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT Cushing's syndrome (CS) is challenging to diagnose. Increased prevalence of CS in specific patient populations has been reported, but routine screening for CS remains questionable. To decrease the diagnostic delay and improve disease outcomes, simple new screening methods for CS in at-risk populations are needed. OBJECTIVE To develop and validate a simple scoring system to predict CS based on clinical signs and an easy-to-use biochemical test. DESIGN Observational, prospective, multicenter. SETTING Referral hospital. PATIENTS A cohort of 353 patients attending endocrinology units for outpatient visits. INTERVENTIONS All patients were evaluated with late-night salivary cortisol (LNSC) and a low-dose dexamethasone suppression test for CS. MAIN OUTCOME MEASURES Diagnosis or exclusion of CS. RESULTS Twenty-six cases of CS were diagnosed in the cohort. A risk scoring system was developed by logistic regression analysis, and cutoff values were derived from a receiver operating characteristic curve. This risk score included clinical signs and symptoms (muscular atrophy, osteoporosis, and dorsocervical fat pad) and LNSC levels. The estimated area under the receiver operating characteristic curve was 0.93, with a sensitivity of 96.2% and specificity of 82.9%. CONCLUSIONS We developed a risk score to predict CS in an at-risk population. This score may help to identify at-risk patients in non-endocrinological settings such as primary care, but external validation is warranted.
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Affiliation(s)
- Antonio León-Justel
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Ainara Madrazo-Atutxa
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Ana I Alvarez-Rios
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Rocio Infantes-Fontán
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Juan A Garcia-Arnés
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Juan A Lillo-Muñoz
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Anna Aulinas
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Eulàlia Urgell-Rull
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Mauro Boronat
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Ana Sánchez-de-Abajo
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Carmen Fajardo-Montañana
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Mario Ortuño-Alonso
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Isabel Salinas-Vert
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Maria L Granada
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - David A Cano
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Alfonso Leal-Cerro
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
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Steffensen C, Thomsen HH, Dekkers OM, Christiansen JS, Rungby J, Jørgensen JOL. Low positive predictive value of midnight salivary cortisol measurement to detect hypercortisolism in type 2 diabetes. Clin Endocrinol (Oxf) 2016; 85:202-6. [PMID: 27028214 DOI: 10.1111/cen.13071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/07/2016] [Accepted: 03/28/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hypercortisolism is prevalent in type 2 diabetes (T2D), but analytical and functional uncertainties prevail. Measurement of salivary cortisol is considered an expedient screening method for hypercortisolism, but its usefulness in the context of T2D is uncertain. AIM To compare late-night salivary cortisol (LNSC) with the 1 mg overnight dexamethasone suppression test (DST), which was considered 'reference standard', in T2D. PATIENTS AND METHODS A total of 382 unselected and recently diagnosed patients with T2D underwent assessment of LNSC and DST, and the test outcome was related to age, gender, body mass index (BMI) and haemoglobin A1c levels. We used the following cut-off values: LNSC ≤ 3·6 nmol/l and DST ≤ 50 nmol/l. RESULTS The median (range) levels of LNSC and DST were 6·1 (0·3-46·2) nmol/l and 34 (11-547) nmol/l, respectively. Hypercortisolism was present in 86% based on LNSC values and 22% based on DST. LNSC, as compared to DST, had the following test characteristics: sensitivity: 85% (95% CI: 7-92%), specificity: 14% (95% CI: 10-19%), positive predictive value: 22% (95% CI: 17-27%), negative predictive value: 76% (95% CI: 63-87%), and overall accuracy: 30% (95% CI: 25-34%). LNSC and DST values were not associated with haemoglobin A1c, BMI and age in this cohort of patients with T2D. CONCLUSION The LNSC is characterized by very low specificity and poor positive predictive value as compared to the DST, resulting in an overall low accuracy. Further methodological and clinical studies are needed to substantiate the relevance of cortisol status in T2D.
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Affiliation(s)
- Charlotte Steffensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik H Thomsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Medicine, Viborg Regional Hospital, Aarhus, Denmark
| | - Olaf M Dekkers
- Department of Medicine, Section Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jens S Christiansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Rungby
- Centre for Diabetes Research, Gentofte University Hospital, Hellerup, Denmark
| | - Jens Otto L Jørgensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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Costa DS, Conceição FL, Leite NC, Ferreira MT, Salles GF, Cardoso CRL. Prevalence of subclinical hypercortisolism in type 2 diabetic patients from the Rio de Janeiro Type 2 Diabetes Cohort Study. J Diabetes Complications 2016; 30:1032-8. [PMID: 27210052 DOI: 10.1016/j.jdiacomp.2016.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/16/2016] [Accepted: 05/04/2016] [Indexed: 12/29/2022]
Abstract
AIMS Subclinical hypercortisolism was reported to be more prevalent among diabetic, obese and hypertensive patients. Our primary aim was to investigate the prevalence of subclinical hypercortisolism in patients from the Rio de Janeiro Type 2 Diabetes (RIO-T2D) Cohort; and secondarily to assess its associated factors. METHODS From May 2013 to August 2014, 393 diabetic outpatients underwent overnight 1mg dexamethasone suppression test (DST). Patients with non-suppressive morning cortisol (≥1.8μg/dl) were further evaluated with nocturnal salivary cortisol, two readings >0.35μg/dl were considered confirmatory for subclinical hypercortisolism. RESULTS One-hundred twenty-eight patients (32.6%) failed to suppress morning cortisol, and in 33 patients (8.6%) subclinical hypercortisolism was confirmed. Independent correlates of a positive DST were older age (OR: 1.04; 95% CI: 1.01-1.07; p=0.007), number of anti-hypertensive drugs in use (OR: 1.26; 95% CI: 1.05-1.50; p=0.012), longer diabetes duration (OR: 1.03; 95% CI: 1.004-1.06; p=0.023), and presence of diabetic nephropathy (OR: 1.70; 95% CI: 1.01-2.87; p=0.047). Independent correlates of confirmed subclinical hypercortisolism were a greater number of anti-hypertensive medications (OR: 1.54; 95% CI: 1.14-2.06; p=0.004), shorter diabetes duration (OR: 0.92; 95% CI: 0.87-0.98; p=0.006), and increased aortic stiffness (OR: 2.81; 95% CI: 1.20-6.57; p=0.017); metformin use was protective (OR: 0.27; 95% CI: 0.10-0.73; p=0.010). CONCLUSION Patients with type 2 diabetes had a high prevalence of subclinical hypercortisolism, and its presence was associated with more severe hypertension and increased aortic stiffness.
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Affiliation(s)
- Denise S Costa
- Department of Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rua Rodolpho Paulo Rocco 255, Cidade Universitária-Ilha do Fundão Rio de Janeiro-RJ, Brazil, CEP: 21941-913
| | - Flavia L Conceição
- Department of Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rua Rodolpho Paulo Rocco 255, Cidade Universitária-Ilha do Fundão Rio de Janeiro-RJ, Brazil, CEP: 21941-913
| | - Nathalie C Leite
- Department of Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rua Rodolpho Paulo Rocco 255, Cidade Universitária-Ilha do Fundão Rio de Janeiro-RJ, Brazil, CEP: 21941-913
| | - Marcel T Ferreira
- Department of Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rua Rodolpho Paulo Rocco 255, Cidade Universitária-Ilha do Fundão Rio de Janeiro-RJ, Brazil, CEP: 21941-913
| | - Gil F Salles
- Department of Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rua Rodolpho Paulo Rocco 255, Cidade Universitária-Ilha do Fundão Rio de Janeiro-RJ, Brazil, CEP: 21941-913
| | - Claudia R L Cardoso
- Department of Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rua Rodolpho Paulo Rocco 255, Cidade Universitária-Ilha do Fundão Rio de Janeiro-RJ, Brazil, CEP: 21941-913.
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36
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Bellastella G, Maiorino MI, De Bellis A, Vietri MT, Mosca C, Scappaticcio L, Pasquali D, Esposito K, Giugliano D. Serum but not salivary cortisol levels are influenced by daily glycemic oscillations in type 2 diabetes. Endocrine 2016; 53:220-6. [PMID: 26511948 DOI: 10.1007/s12020-015-0777-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
Abstract
Diurnal salivary and plasma cortisol variations are considered valid expression of circadian cortisol rhythmicity. The aim of this study was to assess the reliability of salivary and plasma cortisol and if glycemia and glycemic oscillations may interfere with their concentration. Forty-seven type 2 diabetic patients and 31 controls were studied for glycemic profile and diurnal salivary and plasma cortisol variations on two contemporary samples taken at 08:00 a.m.-11:00 p.m (Late Night, LN). Glucose variability was evaluated in diabetic patients by considering the standard deviation of blood glucose (BGSD) readings, by calculating the mean amplitude of glycemic excursions (MAGEs) and continuous overlapping net glycemic action (CONGA). A significant correlation between LN serum cortisol and morning fasting glycemia (r = 0.78; p = 0.004) was observed in T2DM group but not in the control group (r = 0.09; p = 0.74). While LN serum cortisol significantly correlated with CONGA in diabetic patients (r = 0.50; p < 0.001), LN salivary cortisol did not correlate with any indices of glucose variability. Moreover, a highly significant correlation between LN salivary and LN serum cortisol concentrations was found in control group (r = 0.80; p < 0.001) but not in diabetic patients (r = 0.07; p = 0.62). This study shows for the first time that LN salivary rather than plasma cortisol may give information on the dynamics of adrenal function of type 2 diabetic patients, as it is not significantly influenced by glycemic variations. However, our preliminary results need to be confirmed by further studies with more complete evaluations including many more patients.
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Affiliation(s)
- Giuseppe Bellastella
- Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Piazza L. Miraglia 2, 80138, Naples, Italy.
| | - Maria Ida Maiorino
- Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Piazza L. Miraglia 2, 80138, Naples, Italy
| | - Annamaria De Bellis
- Endocrinology and Metabolic Diseases Unit, Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy
| | - Maria Teresa Vietri
- Department of Biochemistry, Biophysics and General Pathology, Second University of Naples, Naples, Italy
| | - Carmela Mosca
- Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Piazza L. Miraglia 2, 80138, Naples, Italy
| | - Lorenzo Scappaticcio
- Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Piazza L. Miraglia 2, 80138, Naples, Italy
| | - Daniela Pasquali
- Endocrinology and Metabolic Diseases Unit, Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy
| | - Katherine Esposito
- Diabetes Unit, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Dario Giugliano
- Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Piazza L. Miraglia 2, 80138, Naples, Italy
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Spanakis EK, Wang X, Sánchez BN, Diez Roux AV, Needham BL, Wand GS, Seeman T, Golden SH. Lack of significant association between type 2 diabetes mellitus with longitudinal change in diurnal salivary cortisol: the multiethnic study of atherosclerosis. Endocrine 2016; 53:227-39. [PMID: 26895003 PMCID: PMC4902713 DOI: 10.1007/s12020-016-0887-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/02/2016] [Indexed: 02/02/2023]
Abstract
Cross-sectional association has been shown between type 2 diabetes and hypothalamic-pituitary-adrenal (HPA) axis dysregulation; however, the temporality of this association is unknown. Our aim was to determine if type 2 diabetes is associated with longitudinal change in daily cortisol curve features. We hypothesized that the presence of type 2 diabetes may lead to a more blunted and abnormal HPA axis profile over time, suggestive of increased HPA axis dysregulation. This was a longitudinal cohort study, including 580 community-dwelling individuals (mean age 63.7 ± 9.1 years; 52.8 % women) with (n = 90) and without (n = 490) type 2 diabetes who attended two MultiEthnic Study of Atherosclerosis Stress ancillary study exams separated by 6 years. Outcome measures that were collected were wake-up and bedtime cortisol, cortisol awakening response (CAR), total area under the curve (AUC), and early, late, and overall decline slopes. In univariate analyses, wake-up and AUC increased over 6 years more in persons with as compared to those without type 2 diabetes (11 vs. 7 % increase for wake-up and 17 vs. 11 % for AUC). The early decline slope became flatter over time with a greater flattening observed in diabetic compared to non-diabetic individuals (23 vs. 9 % flatter); however, the change was only statistically significant for wake-up cortisol (p-value: 0.03). Over time, while CAR was reduced more, late decline and overall decline became flatter, and bedtime cortisol increased less in those with as compared to those without type 2 diabetes, none of these changes were statistically significant in adjusted models. We did not identify any statistically significant change in cortisol curve features over 6 years by type 2 diabetes status.
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Affiliation(s)
- Elias K Spanakis
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 333, Baltimore, MD, 21287, USA
| | - Xu Wang
- Department of Epidemiology, Drexel University School of Public Health, Philadelphia, PA, USA
| | - Brisa N Sánchez
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Ana V Diez Roux
- Department of Epidemiology, Drexel University School of Public Health, Philadelphia, PA, USA
| | - Belinda L Needham
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Gary S Wand
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 333, Baltimore, MD, 21287, USA
| | - Teresa Seeman
- Division of Geriatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sherita Hill Golden
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 333, Baltimore, MD, 21287, USA.
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Javorsky BR, Carroll TB, Tritos NA, Salvatori R, Heaney AP, Fleseriu M, Biller BMK, Findling JW. Discovery of Cushing's Syndrome After Bariatric Surgery: Multicenter Series of 16 Patients. Obes Surg 2016; 25:2306-13. [PMID: 25917980 DOI: 10.1007/s11695-015-1681-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE The aim of this study is to demonstrate the importance of considering Cushing's syndrome (CS) as a potential etiology for weight gain and metabolic complications in patients undergoing bariatric surgery (BS). DESIGN AND METHODS This is a retrospective chart review case series of patients (n = 16) with CS from five tertiary care centers in the USA who had BS. RESULTS Median age at BS surgery was 35.5 years (median 2.5 years between BS and CS surgery). CS was not identified in 12 patients prior to BS. Four patients had CS surgery prior to BS, without recognition of recurrent or persistent CS until after BS. Median body mass index (BMI) values before BS, nadir after BS, prior to surgery for CS, and after surgery for CS were 47, 31, 38, and 35 kg/m(2), respectively. Prior to BS, 55 % of patients had hypertension and 55 % had diabetes mellitus. Only 17 % had resolution of hypertension or diabetes mellitus after BS. CONCLUSION CS may be under-recognized in patients undergoing BS. Testing for CS should be performed prior to BS in patients with features of CS and in post-operative BS patients with persistent hypertension, diabetes mellitus, or excessive weight regain. Studies should be conducted to determine the role of prospective testing for CS in subjects considering BS.
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Affiliation(s)
- Bradley R Javorsky
- Endocrinology Center and Clinics, Froedtert and Medical College of Wisconsin, W129 N7055 Northfield Drive, Building A, Suite 203 Menomonee Falls, Milwaukee, WI, 53051, USA.
| | - Ty B Carroll
- Endocrinology Center and Clinics, Froedtert and Medical College of Wisconsin, W129 N7055 Northfield Drive, Building A, Suite 203 Menomonee Falls, Milwaukee, WI, 53051, USA
| | - Nicholas A Tritos
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Roberto Salvatori
- Division of Endocrinology, Diabetes and Metabolism and Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Maria Fleseriu
- Departments of Medicine and Neurological Surgery, Northwest Pituitary Center, Oregon Health & Science University, Portland, OR, USA
| | | | - James W Findling
- Endocrinology Center and Clinics, Froedtert and Medical College of Wisconsin, W129 N7055 Northfield Drive, Building A, Suite 203 Menomonee Falls, Milwaukee, WI, 53051, USA
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Machado MC, Fragoso MCBV, Moreira AC, Boguszewski CL, Vieira L, Naves LA, Vilar L, de Araújo LA, Czepielewski MA, Gadelha MR, Musolino NRC, Miranda PAC, Bronstein MD, Ribeiro-Oliveira A. Recommendations of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism for the diagnosis of Cushing's disease in Brazil. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2016; 60:267-86. [PMID: 27355856 PMCID: PMC10522300 DOI: 10.1590/2359-3997000000174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/10/2016] [Indexed: 11/22/2022]
Abstract
Although it is a rare condition, the accurate diagnosis and treatment of Cushing's disease is important due to its higher morbidity and mortality compared to the general population, which is attributed to cardiovascular diseases, diabetes mellitus and infections. Screening for hypercortisolism is recommended for patients who present multiple and progressive clinical signs and symptoms, especially those who are considered to be more specific to Cushing's syndrome, abnormal findings relative to age (e.g., spinal osteoporosis and high blood pressure in young patients), weight gain associated with reduced growth rate in the pediatric population and for those with adrenal incidentalomas. Routine screening is not recommended for other groups of patients, such as those with obesity or diabetes mellitus. Magnetic resonance imaging (MRI) of the pituitary, the corticotropin-releasing hormone (CRH) test and the high-dose dexamethasone suppression test are the main tests for the differential diagnosis of ACTH-dependent Cushing's syndrome. Bilateral and simultaneous petrosal sinus sampling is the gold standard method and is performed when the triad of initial tests is inconclusive, doubtful or conflicting. The aim of this article is to provide information on the early detection and establishment of a proper diagnosis of Cushing's disease, recommending follow-up of these patients at experienced referral centers. Arch Endocrinol Metab. 2016;60(3):267-86.
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Affiliation(s)
- Márcio Carlos Machado
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Neuroendocrinologia, Serviço de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP); Departamento de Endocrinologia, A.C. Camargo Cancer Center, São Paulo, SP, Brasil;
| | - Maria Candida Barisson Vilares Fragoso
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Neuroendocrinologia, Serviço de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP); Departamento de Endocrinologia, A.C. Camargo Cancer Center, São Paulo, SP, Brasil;
| | - Ayrton Custódio Moreira
- Faculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrasilDivisão de Endocrinologia e Metabologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brasil;
| | - César Luiz Boguszewski
- Serviço de Endocrinologia e MetabologiaHospital de ClínicasUniversidade Federal do ParanáCuritibaPRBrasilServiço de Endocrinologia e Metabologia (SEMPR), Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brasil;
| | - Leonardo Vieira
- Serviço de EndocrinologiaHospital Universitário Clementino Fraga FilhoUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilServiço de Endocrinologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (HUCFF/UFRJ), Rio de Janeiro, RJ, Brasil;
| | - Luciana A. Naves
- Serviço de EndocrinologiaHospital Universitário de BrasíliaUniversidade de BrasíliaBrasíliaDFBrasilServiço de Endocrinologia, Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, DF, Brasil;
| | - Lucio Vilar
- Serviço de EndocrinologiaHospital de ClínicasUniversidade Federal de PernambucoRecifePEBrasilServiço de Endocrinologia, Hospital de Clínicas, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brasil;
| | | | - Mauro A. Czepielewski
- Hospital de Clínicas de Porto AlegreFaculdade de MedicinaUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasilServiço de Endocrinologia, Hospital de Clínicas de Porto Alegre (HCPA), Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil;
| | - Monica R. Gadelha
- Serviço de EndocrinologiaHospital Universitário Clementino Fraga FilhoUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilServiço de Endocrinologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (HUCFF/UFRJ), Rio de Janeiro, RJ, Brasil;
| | - Nina Rosa Castro Musolino
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Neuroendocrinologia, Divisão de Neurocirurgia Funcional, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP;Brasil
| | - Paulo Augusto C Miranda
- Serviço de EndocrinologiaSanta Casa de Belo HorizonteBelo HorizonteMGBrasilServiço de Endocrinologia, Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brasil;
| | - Marcello Delano Bronstein
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Neuroendocrinologia, Serviço de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP); Departamento de Endocrinologia, A.C. Camargo Cancer Center, São Paulo, SP, Brasil;
| | - Antônio Ribeiro-Oliveira
- Universidade Federal de Minas GeraisServiço de EndocrinologiaHospital de ClínicasBelo HorizonteMGBrasilServiço de Endocrinologia, Hospital de Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil
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Radahmadi M, Alaei H, Sharifi MR, Hosseini N. Stress biomarker responses to different protocols of forced exercise in chronically stressed rats. J Bodyw Mov Ther 2016; 21:63-68. [PMID: 28167192 DOI: 10.1016/j.jbmt.2016.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 05/02/2016] [Accepted: 05/14/2016] [Indexed: 11/26/2022]
Abstract
Stress is one of the most significant causes of major health problems on a global scale. The beneficial effects of exercise on combating stress, however, are well-established. The present study investigated the stress biomarker responses, such as serum corticosterone, interlukin-1β, and glucose levels, to different (preventive, therapeutic, protective, and continuous) protocols of forced exercise under stress. Male rats were randomly allocated to the following five groups: stressed, preventive, therapeutic, protective, and continuous (and/or pre-stress, post-stress, stress-accompanied, and both pre-stress and stress-accompanied exercise respectively) exercise groups. Stress was applied 6 h/day for 21 days and the treadmill running was employed at a speed of 20-21 m/min for 21 and 42 days. The findings showed that the therapeutic, protective, and continuous exercises led to reduced corticosterone and glucose levels. Whereas, the preventive exercise did not reverse the stress responses, and that the therapeutic exercise led to a significant decline in serum interlukin-1β. It is concluded that protective, therapeutic, and, particularly, continuous exercises lead to significant reductions in serum corticosterone and the associated stress-induced hyperglycemia. Moreover, it appears that the timing and duration of exercise are the two factors contributing to changes in stress biomarker responses.
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Affiliation(s)
- Maryam Radahmadi
- Department of Physiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Hojjatallah Alaei
- Department of Physiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Sharifi
- Department of Physiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasrin Hosseini
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
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41
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Cushing’s syndrome in obese patients with type 2 diabetes: A single center screening study. Int J Diabetes Dev Ctries 2016. [DOI: 10.1007/s13410-016-0494-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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42
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Saiegh L, Keren D, Rainis T, Sheikh-Ahmad M, Reut M, Nakhleh A, Wirsansky I, Chen-Konak L, Schiff E, Shechner C. Dexamethasone-suppressed corticotropin-releasing hormone stimulation test in morbid obese adults. Obes Res Clin Pract 2016; 10:275-82. [DOI: 10.1016/j.orcp.2015.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/11/2015] [Accepted: 07/13/2015] [Indexed: 12/25/2022]
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43
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Lammert A, Nittka S, Otto M, Schneider-Lindner V, Kemmer A, Krämer BK, Birck R, Hammes HP, Benck U. Performance of the 1 mg dexamethasone suppression test in patients with severe obesity. Obesity (Silver Spring) 2016; 24:850-5. [PMID: 26948683 DOI: 10.1002/oby.21442] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 12/01/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To analyze the performance of the 1 mg dexamethasone suppression test (DST) in patients with obesity. Special attention was paid to the influence of interfering medication on DST. METHODS In this prospective cohort study (Mannheim Obesity Study), patients with obesity were evaluated before bariatric surgery. For evaluation of hypercortisolism, a 1 mg dexamethasone-suppression test (DST) in all subjects was performed. Medication was assessed for possible interference. RESULTS Two hundred seventy-eight patients with a mean age of 42.3 years (68.8% women) and a mean BMI of 47.9 ± 8.4 kg/m(2) were screened. Insufficient suppression of cortisol after DST was found in 24 patients (8.6%). In two patients hypercortisolism was confirmed. The specificity for DST was calculated at 92.0%. Only CYP3A4 inducers (n = 22, 7.9%) and estrogen therapy (n = 17, 6.1%) were significantly associated with falsely elevated cortisol after DST. Regression analysis excluded any interrelation between DST and anthropometry. CONCLUSIONS Low prevalence of hypercortisolism (0.7 or <1.8%) was found. Specificity of DST in this cohort typically screened for hypercortisolism was 92.0% (≤ 50 nmol/L). DST should be avoided in patients taking CYP3A4 inducers or estrogen therapy, due to their significant interaction. In summary, the 1 mg DST is an adequate test for screening for hypercortisolism even in patients with extreme obesity.
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Affiliation(s)
- Alexander Lammert
- 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stefanie Nittka
- Institute for Clinical Chemistry, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Mirko Otto
- Department of Surgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Verena Schneider-Lindner
- Department of Anesthesiology and Surgical Intensive Care Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Anne Kemmer
- 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Bernhard K Krämer
- 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Rainer Birck
- 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Hans-Peter Hammes
- 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Urs Benck
- 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
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Asao T, Oki K, Yoneda M, Tanaka J, Kohno N. Hypothalamic-pituitary-adrenal axis activity is associated with the prevalence of chronic kidney disease in diabetic patients. Endocr J 2016; 63:119-26. [PMID: 26537094 DOI: 10.1507/endocrj.ej15-0360] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Progression of chronic kidney disease (CKD) in diabetic patients can occur through enhanced hypothalamic-pituitary-adrenal (HPA) axis activity. The purpose of our study was to determine whether HPA axis activity influences the prevalence of CKD in patients with type 2 diabetes mellitus. Seventy-seven diabetic patients (mean age, 60 years) were enrolled. CKD was defined by K/DOQI criteria, and serum cortisol level was measured after the 1 mg overnight dexamethasone suppression test (F-DST). F-DST values were significantly negatively correlated with estimated glomerular filtration rate (eGFR), and significantly positively correlated with cystatin C level and spot urine albumin to creatinine ratio in simple and multiple regression analyses. The subjects were divided into 3 groups (low, middle, and high) according to the F-DST, and the odds for CKD were 8.7-fold (95% confidence interval 2.56 to 29.6, P=0.01) and 12.5-fold (95% confidence interval 3.3 to 47.9, P<0.001) higher in subjects in the middle and high groups than those in the low group, respectively. In multivariate regression analysis, subjects in the middle group and high group (compared to those in the low group) had 13.0-fold (95% confidence interval, 2.9 to 58.8 and P=0.001) and 14.7-fold (95% confidence interval, 2.8 to 78.5 and P=0.002), respectively, higher risk for CKD. In conclusion, F-DST values have a relationship with decreased eGFR and increased cystatin C or albumin excretion involved in CKD, and enhanced HPA axis activity may be an independent risk factor for CKD in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Takako Asao
- Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Budyal S, Jadhav SS, Kasaliwal R, Patt H, Khare S, Shivane V, Lila AR, Bandgar T, Shah NS. Is it worthwhile to screen patients with type 2 diabetes mellitus for subclinical Cushing's syndrome? Endocr Connect 2015; 4:242-8. [PMID: 26420669 PMCID: PMC4621608 DOI: 10.1530/ec-15-0078] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 09/28/2015] [Indexed: 11/08/2022]
Abstract
Variable prevalence of subclinical Cushing's syndrome (SCS) has been reported in patients with type 2 diabetes mellitus (T2DM), making the need for screening in this population uncertain. It is unknown if this variability is solely due to study-related methodological differences or a reflection of true differences in ethnic predisposition. The objective of this study is to explore the prevalence of SCS in Asian Indian patients with T2DM. In this prospective single center study conducted in a tertiary care referral center, 993 T2DM outpatients without any discriminatory clinical features (easy bruising, facial plethora, proximal muscle weakness, and/or striae) of hypercortisolism underwent an overnight 1 mg dexamethasone suppression test (ODST). ODST serum cortisol ≥1.8 μg/dl was considered positive, and those with positive results were subjected to 48 h, 2 mg/day low dose DST (LDDST). A stepwise evaluation for endogenous hypercortisolism was planned for patients with LDDST serum cortisol ≥1.8 μg/dl. Patients with positive ODST and negative LDDST were followed up clinically and re-evaluated a year later for the development of clinically evident Cushing's syndrome (CS). In this largest single center study reported to date, we found 37 out of 993 (3.72%) patients had ODST serum cortisol ≥1.8 μg/dl. None of them had LDDST cortisol ≥1.8 μg/dl, nor did they develop clinically evident CS over a follow-up period of 1 year. Specificity of ODST for screening of CS was 96.3% in our cohort. None of the T2DM outpatients in our cohort had SCS, hence cautioning against routine biochemical screening for SCS in this cohort. We suggest screening be based on clinical suspicion only.
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Affiliation(s)
- Sweta Budyal
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400012, India
| | - Swati Sachin Jadhav
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400012, India
| | - Rajeev Kasaliwal
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400012, India
| | - Hiren Patt
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400012, India
| | - Shruti Khare
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400012, India
| | - Vyankatesh Shivane
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400012, India
| | - Anurag R Lila
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400012, India
| | - Tushar Bandgar
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400012, India
| | - Nalini S Shah
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400012, India
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Schmidt TH, Shinkai K. Evidence-based approach to cutaneous hyperandrogenism in women. J Am Acad Dermatol 2015; 73:672-90. [PMID: 26138647 DOI: 10.1016/j.jaad.2015.05.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 05/15/2015] [Accepted: 05/16/2015] [Indexed: 10/23/2022]
Abstract
Hirsutism, acne, and androgenetic alopecia are classically considered signs of cutaneous hyperandrogenism (CHA). These common skin findings have significant impacts on the quality of patients' lives and pose the diagnostic challenge of excluding underlying disorders. Many with CHA have normal serum androgen levels. Hirsutism is more strongly associated with hyperandrogenism than are acne or androgenetic alopecia. Variable association of CHA with hyperandrogenemia results from the complexity of the underlying pathophysiology, including factors local to the pilosebaceous unit. CHA often occurs in the setting of polycystic ovary syndrome, the most common disorder of hyperandrogenism, but can also present in uncommon conditions, including nonclassic adrenal hyperplasia and androgen-producing tumors. A thorough history and full skin examination are important to guide appropriate diagnostic evaluation. Oral contraceptive pills with or without antiandrogens can provide therapeutic benefit for hirsutism and acne. Medical options for androgenetic alopecia remain limited. Multidisciplinary approaches may be needed given endocrine, metabolic, reproductive, and psychiatric disorders associated with CHA. More high-quality studies into the mechanisms of CHA and the benefits of antiandrogenic therapies are needed. We provide an evidence-based review of key diagnostic and therapeutic considerations in the treatment of women with CHA.
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Affiliation(s)
- Timothy H Schmidt
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Kanade Shinkai
- Department of Dermatology, University of California San Francisco, San Francisco, California.
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Galland F, Vantyghem MC, Cazabat L, Boulin A, Cotton F, Bonneville JF, Jouanneau E, Vidal-Trécan G, Chanson P. Management of nonfunctioning pituitary incidentaloma. ANNALES D'ENDOCRINOLOGIE 2015; 76:191-200. [PMID: 26054868 DOI: 10.1016/j.ando.2015.04.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 04/29/2015] [Indexed: 11/27/2022]
Abstract
Prevalence of pituitary incidentaloma is variable: between 1.4% and 27% at autopsy, and between 3.7% and 37% on imaging. Pituitary microincidentalomas (serendipitously discovered adenoma <1cm in diameter) may increase in size, but only 5% exceed 10mm. Pituitary macroincidentalomas (serendipitously discovered adenoma>1cm in diameter) show increased size in 20-24% and 34-40% of cases at respectively 4 and 8years' follow-up. Radiologic differential diagnosis requires MRI centered on the pituitary gland. Initial assessment of nonfunctioning (NF) microincidentaloma is firstly clinical, the endocrinologist looking for signs of hypersecretion (signs of hyperprolactinemia, acromegaly or Cushing's syndrome), followed up by systematic prolactin and IGF-1 assay. Initial assessment of NF macroincidentaloma is clinical, the endocrinologist looking for signs of hormonal hypersecretion or hypopituitarism, followed up by hormonal assay to screen for hypersecretion or hormonal deficiency and by ophthalmologic assessment (visual acuity and visual field) if and only if the lesion is near the optic chiasm (OC). NF microincidentaloma of less than 5mm requires no surveillance; those of≥5mm are not operated on but rather monitored on MRI at 6months and then 2years. Macroincidentaloma remote from the OC is monitored on MRI at 1year, with hormonal exploration (for anterior pituitary deficiency), then every 2years. When macroincidentaloma located near the OC is managed by surveillance rather than surgery, MRI is recommended at 6months, with hormonal and visual exploration, then annual MRI and hormonal and visual assessment every 6months. Surgery is indicated in the following cases: evolutive NF microincidentaloma, NF macroincidentaloma associated with hypopituitarism or showing progression, incidentaloma compressing the OC, possible malignancy, non-compliant patient, pregnancy desired in the short-term, or context at risk of apoplexy.
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Affiliation(s)
- Françoise Galland
- Service d'Endocrinologie, Diabétologie, Nutrition, CHU de Rennes Hôpital Sud, 16, boulevard de Bulgarie, 35000 Rennes, France
| | | | - Laure Cazabat
- Département d'Endocrinologie, CHU Ambroise-Paré, AP-HP, Boulogne, France
| | - Anne Boulin
- Département d'Endocrinologie, CHU Ambroise-Paré, AP-HP, Boulogne, France
| | - François Cotton
- Département de Biochimie Clinique, Hôpital Erasme, Université Libre de Bruxelles, route de Lennik, 808, 1070 Brussels, Belgium
| | | | - Emmanuel Jouanneau
- Département de Neurochirurgie B, Pierre-Wertheimer - Hospices Civils de Lyon, Lyon, France
| | - Gwénaelle Vidal-Trécan
- Département d'Épidemiologie et Évaluation des Politiques de Santé, Université Paris Descartes, Paris Sorbonne Cité, Paris, France
| | - Philippe Chanson
- Service d'Endocrinologie et des Maladies de la Reproduction, Hôpital de Bicêtre, AP-HP, 94275 Le Kremlin-Bicêtre, France; UMR S693, Faculté de Médecine Paris-Sud, Université Paris-Sud 11, 94276 Le Kremlin-Bicêtre, France; Inserm U693, 94276 Le Kremlin-Bicêtre, France.
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48
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Broder MS, Neary MP, Chang E, Cherepanov D, Ludlam WH. Incidence of Cushing's syndrome and Cushing's disease in commercially-insured patients <65 years old in the United States. Pituitary 2015; 18:283-9. [PMID: 24803324 DOI: 10.1007/s11102-014-0569-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To estimate the incidence of Cushing's syndrome (CS) and Cushing's disease (CD) in the US. METHODS MarketScan Commercial database 2007-2010 (age <65 years) was used. CS patients were defined with ≥2 claims of CS diagnosis, while CD patients were defined with CS plus a benign pituitary adenoma diagnosis or hypophysectomy in the same calendar year. Annual incidence was calculated by dividing the number of CS or CD cases by the total number of members with the same enrollment requirement during the calendar years. RESULTS CS incidence rates per million person-years were 48.6 in 2009 and 39.5 in 2010. The lowest rates of CS were in ≤17-year-olds and highest rates were in 35 to 44-year-olds. CD incidence rates were 7.6 in 2009 and 6.2 in 2010. The lowest rates of CD were in ≤17-year-olds and highest rates were in 18 to 24-year-olds. The rates varied by sex (2.3-2.7 in males, 9.8-12.1 in females). In females, lowest rates ranged 2.5-4.0 in ≤17-year-olds and highest 16.7-27.2 in 18-24 year olds. In males, there were too few cases to report estimates by age. CONCLUSIONS In the first large US-based study, the annual incidence of CS in individuals <65 years old was nearly 49 cases per million, substantially higher than previous estimates, which were based primarily on European data. Using similar methods, we estimated the incidence of CD at nearly 8 cases per million US population. These estimates, if confirmed in other epidemiologic databases, represent a new data reference in these rare conditions.
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Affiliation(s)
- Michael S Broder
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Drive, Suite 404, Beverly Hills, CA, 90212, USA
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Sharma ST, Nieman LK, Feelders RA. Cushing's syndrome: epidemiology and developments in disease management. Clin Epidemiol 2015; 7:281-93. [PMID: 25945066 PMCID: PMC4407747 DOI: 10.2147/clep.s44336] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cushing’s syndrome is a rare disorder resulting from prolonged exposure to excess glucocorticoids. Early diagnosis and treatment of Cushing’s syndrome is associated with a decrease in morbidity and mortality. Clinical presentation can be highly variable, and establishing the diagnosis can often be difficult. Surgery (resection of the pituitary or ectopic source of adrenocorticotropic hormone, or unilateral or bilateral adrenalectomy) remains the optimal treatment in all forms of Cushing’s syndrome, but may not always lead to remission. Medical therapy (steroidogenesis inhibitors, agents that decrease adrenocorticotropic hormone levels or glucocorticoid receptor antagonists) and pituitary radiotherapy may be needed as an adjunct. A multidisciplinary approach, long-term follow-up, and treatment modalities customized to each individual are essential for optimal control of hypercortisolemia and management of comorbidities.
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Affiliation(s)
- Susmeeta T Sharma
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Lynnette K Nieman
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Richard A Feelders
- Division of Endocrinology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
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50
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Melnichenko GA, Dedov II, Belaya ZE, Rozhinskaya LY, Vagapova GR, Volkova NI, Grigor’ev AY, Grineva EN, Marova EI, Mkrtumayn AM, Trunin YY, Cherebillo VY. Cushing’s disease: the clinical features, diagnostics, differential diagnostics, and methods of treatment. ACTA ACUST UNITED AC 2015. [DOI: 10.14341/probl201561255-77] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The present guidelines on diagnostics, differential diagnostics, and methods of treatment of Cushing’s disease have been developed by a group of Russian specialists.
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