Endocrine Abstracts

Objectives: The frequency of Cushing’s disease (CD), ACTH independent Cushing’s syndrome (CS) and autonomous cortisol secretion (ACS) in patients with obesity is not well known and the results of the studies are heterogeneous. Therefore, in the present study, we aimed to assess the frequency of CD, CS, and ACS among patients with obesity.

Methods: In this study, 813 consecutive patients [683 female, mean age 46.47±14.23-year-old, mean BMI 37.31±6.50 kg/m²] who were admitted due to obesity between January 2010–December 2015, were retrospectively analyzed. All patients who admit due to obesity to our institution are evaluated for Cushing’s syndrome by clinical and laboratory evaluations. The diagnosis of obesity was made according to BMI and the obesity was classified further to grade 1, 2 and 3, according to the BMI. Serum cortisol levels failed to suppress to < 1.8 μg/dl after overnight 1 mg dexamethasone suppression test (DST) in 44 (5.4%) patients. These patients were evaluated further by 2 days 2 mg DST, 24 hours urinary free cortisol excretion, late-night salivary cortisol, and plasma ACTH levels. The patients with CD, CS and ACS and those without these conditions were compared in terms of gender, age, diabetes, hypertension, and hyperlipidemia.

Results: Forty-four (% 5.4) out of 813 patients were diagnosed as CD, CS or ACS. Five (0.6%) of the patients were lost to follow-up. According to the laboratory, pituitary and upper abdominal MRI results, CD, CS, and ACS were diagnosed in 4 (0.4%), 2 (%0.2) and 33 (4%) out of 39 patients, respectively. Among patients diagnosed as CD, CS and ACS, 4, 2 and 2 patients underwent transsphenoidal surgery and unilateral adrenalectomy, respectively. When patients with CD, CS, and ACS were compared to those without these conditions, older age at diagnosis, and the presence of stage-1 obesity, hypertension, diabetes and uncontrolled DM (Hgb A1c > 7%) were significantly higher in patients with CD, CS and ACS (P=0.001, P=0.007, P=0.004, P=0.038 and P=0.026, respectively).

Conclusions: According to the results of this study, the frequency of CD, CS, and ACS are high among patients with obesity. Therefore, all patients with obesity, particularly patients older than 50 years of age with grade-1 obesity, who also have type-2 diabetes and hypertension, as well as those with uncontrolled diabetes, should be evaluated in terms of CD, CS or ACS.