Endocrine Abstracts

Some studies reports the high prevalence of unsuspected hypercortisolism in high-risk populations.

Aim: To evaluate the prevalence of undiagnosed hypercortisolism in patients with diabetes mellitus (DM), adrenal incidentaloma and obesity.

Material and methods: We prospectively evaluated 30 DM patients (8 male, 22 female, 53.5 years old (18; 73), HbA1c-7.1% (5.6; 13.8)), 22 patients with adrenal incidentaloma (6 male, 16 female, 53.5 years old (20;73)) and 31 obese patients (21 male, 10 female, 22 years old (18;62)). The overnight 1-mg dexamethasone suppression test (DST-1) was done first. If cortisol level exceeded 50 nmol/l after DST-1 (positive result) the additional evaluation was done (2 mg/day for 48 h dexamethasone suppression test (DST-2), urine free cortisol (UFC), midnight salivary cortisol. If the hypercortisolism confirmed the additional examination prepared to found it’s source.

Results: i) DST -1 was positive in 9 of 31 (29%) obese patients. DST-2 reduced the number of positive results to 3 (9.6%). UFC and salivary cortisol were normal in all of them. They did not have clinically apparent hypercortisolism so the DST-2 results interpreted as false-positive. ii) DST-1 was positive in 18 of 30 (58%) patients with DM. After DST-2 the only four (12.9%) of them had positive result. Further investigations revealed Cushing’s syndrome and Cushing`s disease in two of these four patients. Other two patients are in under our observation. It should be noted that patients with confirmed hypercortisolism had clinical signs of hypercortisolism, but referred to our clinic because of uncontrolled DM. iii) DST-1 was positive in 13 of 22 (59%) patients with adrenal incidentaloma. DST-2 was positive in 7 (31.8%) of them. Six of them have Cushing’s syndrome and one is on under observation.

Conclusion: The highest percentage of hypercortisolism revealed in patients with adrenal incidentaloma. High percent of hypercortisolism in DM was due to the fact that their doctor did not suspect overt hypercortisolism.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.