Association of subclinical hypercortisolism with type 2 diabetes mellitus: a case-control study in hospitalized patients

Abstract

Objective: Subclinical hypercortisolism (SH) may play a role in several metabolic disorders, including diabetes. No data are available on the relative prevalence of SH in type 2 diabetes (T2D). In order to compare the prevalence of SH in T2D and matched non-diabetic control individuals, we performed a case-controlled, multicenter, 12-month study, enrolling 294 consecutive T2D inpatients (1.7% dropped out the study) with no evidence of clinical hypercortisolism and 189 consecutive age-and body mass index-matched non-diabetic inpatients (none of whom dropped out). Design and methods: Ascertained SH (ASH) was diagnosed in individuals (i) with plasma cortisol after 1 mg overnight dexamethasone suppression .1.8 mg/dl (50 nmol/l), (ii) with more than one of the following: (a) urinary free cortisol .60.0 mg/24 h (165.6 nmol/24 h), (b) plasma ACTH , 10.0 pg/ml (2.2 pmol/l) or (c) plasma cortisol . 7.5 mg/dl (207 nmol/l) at 24:00 h or .1.4 mg/dl (38.6 nmol/l) after dexamethasone-CRH (serum cortisol after corticotrophin-releasing hormone stimulus during dexamethasone administration) test, and (iii) in whom the source of glucocorticoid excess was suggested by imaging and by additional biochemical tests (for ACTH-dependent ASH). Results: Prevalence of ASH was higher in diabetic individuals than in controls (9.4 versus 2.1%; adjusted odds ratio, 4.8; 95% confidence interval, 1.6-14.1; P ¼ 0.004). In our population the proportion of T2D which is statistically attributable to ASH was approx. 7%. Among diabetic patients, the presence of severe diabetes (as defined by the coexistence of hypertension, dyslipidaemia and insulin treatment) was significantly associated with SH (adjusted odds ratio, 3.8; 95% confidence interval, 1.4 -10.2; P ¼ 0.017). Conclusions: In hospitalized patients, SH is associated with T2D.European Journal of Endocrinology 153 837-844

Discontinuation of BCG Vaccination Precedes Significant Drop in Type 2 Diabetes in Japanese Children. Role of Inflammation and Cortisol Activity as a Cause of Type 2 Diabetes

“…It also does not explain the simultaneous epidemic of type 1 diabetes [11], which occurs primarily in thin patients. The cortisol theory [9,12,13] was based on the observation that small increases in cortisol activity are associated with metabolic disturbances including increased glucose levels, insulin resistance, increased blood pressure, obesity and hyperlipidemia [14]. Metabolic syndrome and related type 2 diabetes resemble mild Cushingoid Syndrome [15,16].…”

Recommendations of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism for the diagnosis of Cushing’s disease in Brazil

“…However, the most studied risk condition is diabetes mellitus, which was found to have a prevalence of 0.8% (0-3.3%) in a group of 2,381 diabetic patients from 12 studies (34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45). Striking Cushing's features have not been described in diabetic patients with an HbA1c between 8.4-12.2% associated with hypertension and overweight/obesity (BMI between 25.4-34.5 kg/m 2 ).…”

The Frequency of Type 2 Diabetic Patients who Meet the Endocrinological Screening Criteria of Subclinical Cushing's Disease

“…A recent American consensus guideline by Nieman et al [21] adopts dexamethasone-CrH test [22] as one of the screening examinations for Cushing's syndrome in the broad sense, including both ACTH-dependent and -independent hypercortisolism. Chiodini et al [23] reported that there were 30 subclinical hypercortisolism cases in 294 diabetics (9.4%), while there were four of them in 189 nondiabetics (2.1%), as screened by dexamethasone-CrH test. Whether this testing is useful in diagnosing subCD has to be examined.…”