title: Diabetes in Cushing Disease.
abstract: This review focuses on the pathophysiological and clinical aspects of diabetes mellitus occurring in patients with Cushing disease (CD).
  
  
  
  Insulin resistance and impairment in insulin secretion are both involved in the pathogenesis of glucocorticoid-induced diabetes. Correction of glucocorticoid excess does not always resolve abnormalities of glucose homeostasis, and correction of hyperglycaemia is specifically required. In fact, insulin resistance may persist even after correction of glucocorticoid excess and diabetes needs to be treated for long term. On the other hand, emerging drugs used in the treatment of CD, such as the novel somatostatin analog pasireotide, may have direct effects on glucose homeostasis regardless of control of cortisol excess. Diabetes mellitus is a frequent and early complication of CD with important diagnostic, prognostic and therapeutic implications. Specifically, diagnosis of CD in patients with diabetes may be difficult due to potential misinterpretation of markers of cortisol hypersecretion. Moreover, diabetes mellitus is often difficult to be controlled in CD requiring a careful and dedicated therapeutic approach. Finally, the coexistence of diabetes may influence the therapeutic decision making in CD, since drugs used in this setting may variably influence glucose homeostasis regardless of control of hypercortisolism.
authors.affiliation: Endocrinology Unit, ASST Carlo Poma, Mantova, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Mazziotti
authors.affiliation: Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
authors.forename: A M
authors.initials: AM
authors.lastname: Formenti
authors.affiliation: Vita-Salute University San Raffaele Milan, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Frara
authors.affiliation: Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Maffezzoni
authors.affiliation: Vita-Salute University San Raffaele Milan, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Doga
authors.affiliation: Vita-Salute University San Raffaele Milan, Milan, Italy. a.giustina@libero.it.
authors.forename: A
authors.initials: A
authors.lastname: Giustina
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D006801:Humans; D007333:Insulin Resistance; D047748:Pituitary ACTH Hypersecretion / Q000150:complications*; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D013004:Somatostatin; D000324:Adrenocorticotropic Hormone; C517782:pasireotide
keywords: Cushing disease; Diabetes:; Somatostatin analogs; hypoglycemic drugs