Endocrine Abstracts

Introduction: Diabetes mellitus (DM) is an expected condition in Cushing syndrome (CS) but there are few data about prevalence and factors associated to occurrence of DM in these patients.

Objective: To determine the main aspects of DM in CS through a systematic review (SR) of the literature.

Methods: MEDLINE and LILACS were searched for studies published until March, 2016. Search strategy comprised the terms “Diabetes Mellitus”, “Glucose Intolerance”, “Hyperglycemia”, “Cushing Syndrome”, “Pituitary ACTH hypersecretion”, “diabete melito”, “Cushing”. Observational/interventional studies in patients with endogenous CS with characterization of DM were included. We excluded case reports, animal models, and studies about exogenous hypercortisolism or subclinical CS.

Results: The initial search yielded 726 titles, 58 were full-text reviewed. Of these, 12 were included in RS. Seven studies (all cross-sectional) accessed DM prevalence. Most patients were women (93.5%) aged 40–50 years, with disease duration between 29 and 180 months. Pituitary, adrenal and ectopic-ACTH were origin of CS in 325 (70.65%), 134 (29%) and 2 (0.5%) patients, respectively. DM prevalence ranged from 17 to 47%. Four studies evaluated the role of body mass index (BMI) on DM occurrence, but none of them found a statistically significant difference. Two studies demonstrated a higher risk of DM in older ages at CS diagnosis. The correlation of DM and severity of hypercortisolism was analysed in four articles and two of them presented a positive result. The effect of CS remission on DM cure was accessed by two studies, with discordant results. DM was associated with higher mortality. Three studies (open-label trials) analysed effect of CS drug therapy on glycaemic control. Mifepristone demonstrated a diabetes improvement after 6 months, as rosiglitazone after 30–120 days.

Conclusion: DM is a frequent CS comorbidity and its occurrence seems to depend on age at diagnosis and disease duration. If CS remission leads to DM remission is still uncertain.