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Horm Metab Res 2019; 51(01): 62-68
DOI: 10.1055/a-0809-3647
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Hypercortisolism in Newly Diagnosed Type 2 Diabetes: A Prospective Study of 384 Newly Diagnosed Patients

Charlotte Steffensen
1   Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
,
Olaf M. Dekkers
2   Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
3   Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
,
Johanne Lyhne
1   Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
,
Bodil G. Pedersen
4   Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
,
Finn Rasmussen
4   Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
,
Jørgen Rungby
5   Department of Clinical Pharmacology, Aarhus University, Aarhus, Denmark
6   Department of Endocrinology IC, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
,
Per Løgstrup Poulsen
1   Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
,
Jens Otto Lunde Jørgensen
1   Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
› Author Affiliations
Further Information

Publication History

received 01 June 2018

accepted 22 November 2018

Publication Date:
06 December 2018 (online)

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Abstract

Cross-sectional studies in small and selected populations report a high prevalence of hypercortisolism in patients with type 2 diabetes (T2D), which could have therapeutic implications, if confirmed. We therefore estimated the prevalence of hypercortisolism in a large and unselected cohort of recently diagnosed T2D patients. Consecutive patients with recently diagnosed T2D first underwent an overnight dexamethasone (1 mg) suppression test (OD). Patients not suppressing serum cortisol ≤50 nmol/l proceeded with a 48-h low dose dexamethasone suppression test (LDDST) and 24-h urinary free cortisol collection (UFC). Patients with elevated cortisol levels according to LDDST and/or UFC underwent imaging guided by plasma ACTH levels, and assessment of bone mineral density. A total of 384 T2D patients (232male/152 females) with a mean age of 60±10 years were included. Eighty-five (22%) patients suppressed incompletely to OD of whom 20 (5%) failed to suppress after LDDST and/or had elevated UFC (=hypercortisolism). Patients with hypercortisolism did not differ as regards age, BMI, HbA1c, T-score or blood pressure, but a higher proportion of them received antihypertensive treatment (100% vs. 64%, p=0.001). Imaging revealed adrenal adenoma(s) in 9 cases and a pituitary macroadenoma in 1 case. We found a 5% prevalence of hypercortisolism in unselected, recently diagnosed T2D, which was not associated with a persuasive cushingoid phenotype. The clinical implications are therefore uncertain.

Key words

cortisol - Cushing’s syndrome - subclinical Cushing’s syndrome - Type 2 diabetes
 

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