ECE2017 Guided Posters Adrenal 2 (10 abstracts)
Hypercortisolism is prevalent in newly diagnosed type 2 diabetes: a prospective study of 384 consecutive patients
Charlotte Steffensen 1 , Olaf M Dekkers 2, , Johanne Lyhne 1 , Per L Poulsen 1 , Jørgen Rungby 4 , Henrik T Sørensen 2 & Jens Otto L Jørgensen 1
1Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark; 2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 3Department of Epidemiology, Leiden University Hospital, Leiden, The Netherlands; 4Department of Clinical Pharmacology, Aarhus University, Aarhus, Denmark.
Background: Cross-sectional studies in small and selected populations indicate a relatively high prevalence of incipient and/or subclinical Cushing’s syndrome (CS) in patients with type 2 diabetes (T2D), which could have therapeutic implications.
Aim: To estimate the prevalence of CS in a large, unselected cohort of recently diagnosed T2D patients.
Methods: A total of 384 consecutive out – patients with T2D diagnosed after 1 January 2009 were investigated by means of an overnight dexamethasone (1 mg) suppression test (DST). Patients who failed to suppress to ≤50 nmol/l after the DST were further examined with 48 h low dose dexamethasone suppression test (LDDST) and 24-h urinary free cortisol collection (UFC). Patients with elevated cortisol levels according to LDDST or UFC underwent ACTH measurements and imaging.
Results: 85 (22%) patients had elevated cortisol after DST of whom 20 (5%) failed to suppress after LDDST and/or had elevated UFC. No significant difference in age, BMI, HbA1c, T-score, Total Body Fat or blood pressure were recorded between the two groups. Among the 20 patients with biochemical CS subsequent imaging with either pituitary MR or abdominal CT, according to suppressed (n=10) or unsuppressed (n=10) ACTH levels, revealed adrenal adenoma(s) in nine cases and a pituitary macroadenoma in one case.
Conclusion: i) The prevalence of hypercortisolism is high in T2D, also in unselected newly diagnosed patients, ii) Hypercortisolism was not associated with a persuasive phenotype, iii) The clinical implications remain uncertain but continued interest is justified, preferably in terms of randomized intervention trials.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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