title: Screening for Cushing's syndrome in obese patients.
abstract: OBJECTIVE
  The aim of this study was to examine the frequency of Cushing's syndrome (CS) in obese patients devoid of specific clinical symptoms of Cushing's syndrome.
  
  
  METHODS
  A total of 150 obese patients (129 female, 21 male; mean age 44.41 +/- 13.34 yr; mean BMI 35.76 +/- 7.13) were included in the study. As a first screening step, we measured 24-h urinary free cortisol (UFC). An overnight 1-mg dexamethasone suppression test was also performed on all patients. Urinary free cortisol levels above 100 microg/24 h were considered to be abnormal. Suppression of serum cortisol <1.8 microg/dL after administration of 1 mg dexamethasone was the cut-off point for normal suppression. The suppression of the serum cortisol levels failed in all of the patients.
  
  
  RESULTS
  MEASURED LABORATORY VALUES WERE AS FOLLOWS: ACTH, median level 28 pg/ml, interquartile range (IQR) 14-59 pg/ml; fasting glucose, 100 (91-113) mg/dL; insulin, 15.7 (7.57-24.45) mU/ml; fT(4), 1.17 (1.05-1.4) ng/dL; TSH, 1.70 (0.91-2.90) mIU/L; total cholesterol, 209 (170.5-250) mg/dL; LDL-c, 136 (97.7-163) mg/dL; HDL-c, 44 (37.25-50.75) mg/dL; VLDL-c, 24 (17-36) mg/dL; triglycerides, 120.5 (86-165) mg/dL. The median UFC level of the patients was 30 microg/24 h (IQR 16-103). High levels of UFC (>100 microg/24 h) were recorded in 37 patients (24%). Cushing's syndrome was diagnosed in 14 of the 150 patients (9.33%). Etiologic reasons for Cushing's syndrome were pituitary microadenoma (9 patients), adrenocortical adenoma (3 patients), and adrenocortical carcinoma (1 patient).
  
  
  CONCLUSIONS
  A significant proportion (9.33%) of patients with simple obesity were found to have Cushing's syndrome. These findings argue that obese patients should be routinely screened for Cushing's syndrome.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical Faculty - Sivas, Turkey.
authors.forename: Ozay
authors.initials: O
authors.lastname: Tiryakioglu
authors.forename: Serdal
authors.initials: S
authors.lastname: Ugurlu
authors.forename: Serap
authors.initials: S
authors.lastname: Yalin
authors.forename: Sibel
authors.initials: S
authors.lastname: Yirmibescik
authors.forename: Erkan
authors.initials: E
authors.lastname: Caglar
authors.forename: Demet Ozgil
authors.initials: DO
authors.lastname: Yetkin
authors.forename: Pinar
authors.initials: P
authors.lastname: Kadioglu
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000652:urine; D001938:Brazil / Q000453:epidemiology; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D008297:Male; D009765:Obesity / Q000150:complications* / Q000652:urine; D012016:Reference Values
chemical_list: D015415:Biomarkers; D005938:Glucocorticoids; D003907:Dexamethasone; D006854:Hydrocortisone