title: Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management.
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.
authors.affiliation: Endocrinology Unit, Department of Medicine, DIMED, University of Padova, Via Ospedale 105, 35128 Padua, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Scaroni
authors.affiliation: Endocrinology Unit, Department of Medicine, DIMED, University of Padova, Via Ospedale 105, 35128 Padua, Italy.
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Zilio
authors.affiliation: Department of Cell Physiology & Metabolism, Centre Médical Universitaire, 1 Rue Michel Servet, 1211 Genèva, Switzerland.
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Foti
authors.affiliation: Endocrinology Unit, Department of Medicine, DIMED, University of Padova, Via Ospedale 105, 35128 Padua, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Boscaro
mesh_terms: D000818:Animals; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D003480:Cushing Syndrome / Q000097:blood / Q000150:complications* / Q000235:genetics / Q000628:therapy; D005938:Glucocorticoids / Q000009:adverse effects / Q000378:metabolism; D044882:Glucose Metabolism Disorders / Q000150:complications* / Q000235:genetics / Q000628:therapy*; D006801:Humans; D006854:Hydrocortisone / Q000009:adverse effects / Q000378:metabolism; D007333:Insulin Resistance / Q000235:genetics; D015398:Signal Transduction / Q000187:drug effects / Q000235:genetics
chemical_list: D001786:Blood Glucose; D005938:Glucocorticoids; D006854:Hydrocortisone