title: Screening of Cushing's syndrome in outpatients with type 2 diabetes: results of a prospective multicentric study in Italy.
abstract: BACKGROUND
  Cushing's syndrome may remain unrecognized among patients referred for metabolic syndrome; thus, a proactive screening has been suggested in certain patient populations with features of the disorder. However, conflicting data have been reported on the prevalence of Cushing's syndrome in patients with type 2 diabetes.
  
  
  OBJECTIVE
  Our aim was to evaluate the prevalence of unsuspected Cushing's syndrome among outpatients with type 2 diabetes.
  
  
  METHODS
  This was a cross-sectional prospective study in 24 diabetes clinics across Italy.
  
  
  METHODS
  Between June 2006 and April 2008, 813 patients with known type 2 diabetes without clinically overt hypercortisolism were evaluated. Follow-up of the study was closed in September 2010. Patients were not selected for characteristics conferring a higher pretest probability of hypercortisolism. Patients underwent a first screening step with the 1-mg overnight dexamethasone suppression test.
  
  
  RESULTS
  Forty patients failed to suppress serum cortisol less than 5.0 μg/dl (138 nmol/liter) and underwent a standard 2-d, 2-mg dexamethasone suppression test, after which six patients (0.6% of the overall series) failed to suppress cortisol less than 1.8 μg/dl (50 nmol/liter), receiving a definitive diagnosis of Cushing's syndrome that was adrenal dependent in five patients. Four patients were cured, being able to discontinue, or reduce, the glucose-lowering agents.
  
  
  CONCLUSIONS
  The present data do not support widespread screening of patients with type 2 diabetes for Cushing's syndrome; however, the disorder is less rare than previously thought when considering epidemiology of type 2 diabetes. Our results support a case-finding approach in patients with uncontrolled diabetes and hypertension despite appropriate treatment.
authors: Medicina Interna I, Dipartimento di Scienze Cliniche e Biologiche, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Regione Gonzole, 10, 10043 Orbassano, Italy. terzolo@usa.net
authors: Massimo
authors: M
authors: Terzolo
authors: Giuseppe
authors: G
authors: Reimondo
authors: Iacopo
authors: I
authors: Chiodini
authors: Roberto
authors: R
authors: Castello
authors: Roberta
authors: R
authors: Giordano
authors: Enrica
authors: E
authors: Ciccarelli
authors: Paolo
authors: P
authors: Limone
authors: Claudio
authors: C
authors: Crivellaro
authors: Irma
authors: I
authors: Martinelli
authors: Marcella
authors: M
authors: Montini
authors: Olga
authors: O
authors: Disoteo
authors: Bruno
authors: B
authors: Ambrosi
authors: Roberto
authors: R
authors: Lanzi
authors: Maura
authors: M
authors: Arosio
authors: Sanzio
authors: S
authors: Senni
authors: Antonio
authors: A
authors: Balestrieri
authors: Erica
authors: E
authors: Solaroli
authors: Bruno
authors: B
authors: Madeo
authors: Raffaella
authors: R
authors: De Giovanni
authors: Felice
authors: F
authors: Strollo
authors: Rodolfo
authors: R
authors: Battista
authors: Alessandro
authors: A
authors: Scorsone
authors: Vito A
authors: VA
authors: Giagulli
authors: Daniela
authors: D
authors: Collura
authors: Aldo
authors: A
authors: Scillitani
authors: Renato
authors: R
authors: Cozzi
authors: Marco
authors: M
authors: Faustini-Fustini
authors: Anna
authors: A
authors: Pia
authors: Roberta
authors: R
authors: Rinaldi
authors: Barbara
authors: B
authors: Allasino
authors: Giulia
authors: G
authors: Peraga
authors: Francesco
authors: F
authors: Tassone
authors: Piernicola
authors: P
authors: Garofalo
authors: Enrico
authors: E
authors: Papini
authors: Giorgio
authors: G
authors: Borretta
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003480:Cushing Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors