title: The frequency of type 2 diabetic patients who meet the endocrinological screening criteria of subclinical Cushing's disease.
abstract: Cushing's syndrome, including its mild form/state of adrenal-dependent subset (subclinical Cushing's syndrome; subCS), is known to enhance glucose intolerance, hypertension and obesity. Recently, subclinical Cushing's disease (subCD) has been identified, but its prevalence and the extent of consequent metabolic derangement are unclear. We screened 90 type 2 diabetic patients hospitalized in our department for subCD, according to the diagnostic guideline proposed by the working group of Japanese Ministry of Health, Welfare and Labor in 2006. Plasma ACTH and cortisol levels in the morning and at midnight were determined, and overnight 0.5 mg dexamethasone suppression test (DST) was performed. Those who showed poor cortisol suppression in DST underwent the desmopressin (DDAVP) test. Fifty-seven patients (63.3%) demonstrated abnormally high midnight cortisol levels (>or=2.5 microg/dL), while only nine of them failed to suppress plasma cortisol levels to <3 microg/dL after DST. Although none of the eight patients who underwent the DDAVP test demonstrated the anticipated paradoxical rise in plasma ACTH, these eight patients (8.9%) endocrinologically met the screening criteria of subCD. Since a considerable percentage of pituitary adenomas causing overt Cushing's disease are not identifiable in magnetic resonance imaging, many of those causing subCD may also be unidentifiable. Further follow-up studies including confirmatory testing and pituitary imaging are necessary.
authors.affiliation: Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Aomori, Japan. hiroshi@zj8.so-net.ne.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Murakami
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nigawara
authors.forename: Satoru
authors.initials: S
authors.lastname: Sakihara
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kageyama
authors.forename: Maki
authors.initials: M
authors.lastname: Yamashita
authors.forename: Kota
authors.initials: K
authors.lastname: Matsuki
authors.forename: Jutaro
authors.initials: J
authors.lastname: Tanabe
authors.forename: Jun
authors.initials: J
authors.lastname: Matsui
authors.forename: Naoki
authors.initials: N
authors.lastname: Tamasawa
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Suda
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000328:Adult; D000368:Aged; D002940:Circadian Rhythm; D003480:Cushing Syndrome / Q000175:diagnosis; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone