Background. Cushing’s syndrome (CS) is a relatively unusual condition that resembles many of the phenotypic features of obesity. Our aim was to evaluate the frequency of CS in obese patients. Materials and Methods. This study included 354 consecutive patients (87.9% female, age years) who presented with simple obesity. All the patients were evaluated for the clinical signs of CS. Lipid parameters, fasting glucose (FPG) and insulin, 75？gr oral glucose tolerance test, basal cortisol and ACTH were measured. 1？mg overnight DST was performed. Results. The mean weight of the patients was ？kg and BMI ？kg/m2. 34.5% of the patients were hypertensive. 36.2% of the patients had central obesity, 72% dorsocervical fat accumulation, 28.8% abdominal striae and 23.2% acne. 49.4% of the women had hirsutism. 46.5% had prediabetes and 12.0% had type 2 diabetes, 72.6% had dyslipidemia. The mean cortisol and ACTH levels were as follows: ？μg/dL and ？pg/mL. Seven patients failed to suppress plasma cortisol to less than 1.8？μg/dL. Biochemical confirmation tests were performed in these patients and 2 of them were diagnosed glucocorticoid-secreting adrenal adenoma. Conclusions. Routine screening for CS in obese patients is not required. 1. Introduction Cushing’s syndrome (CS) is considered a contributing factor to the development of obesity. On the other hand, obesity itself might share the symptoms and signs of CS such as hirsutism, menstrual abnormalities, acne, dorsocervical fat pad (buffalo hump), supraclavicular fullness, glucose intolerance, and hypertension. Physicians may be called upon to exclude CS in obese patients, who are increasingly present in the general population. Early recognition of CS can reduce the morbidity and mortality [1]. The diagnosis of CS is often a challenge for clinicians due to the variable pattern and the nonspecificity of clinical manifestations. The diagnosis can be difficult particularly in states of mild or cyclical or periodical hypercortisolism [2–4]. The suspicion of CS arises in the presence of concomitant recent weight gain, impaired glucose tolerance, and high blood pressure [3]. Several studies reported a 1–5% prevalence of unsuspected CS in patients with poorly controlled type 2 diabetes and/or hypertension [5–8]. However, there are only few studies on the prevalence of CS in obese patients [9–13]. We therefore aimed to evaluate the frequency of CS in patients who present with obesity. The 1？mg overnight dexamethasone-suppression test (DST) is the most frequently used screening tool for CS [14]. Because it is easy to perform and has
References
[1]
J. Etxabe and J. A. Vazquez, “Morbidity and mortality in Cushing's disease: an epidemiological approach,” Clinical Endocrinology, vol. 40, no. 4, pp. 479–484, 1994.
[2]
A. B. Atkinson, D. R. McCance, L. Kennedy, and B. Sheridan, “Cyclical Cushing's syndrome first diagnosed after pituitary surgery: a trap for the unwary,” Clinical Endocrinology, vol. 36, no. 3, pp. 297–300, 1992.
[3]
G. Arnaldi, T. Mancini, B. Kola et al., “Cyclical Cushing’s syndrome in a patient with a bronchial neuroendocrine tumor (typical carcinoid) expressing ghrelin and growth hormone secretagogue receptors,” Journal of Clinical Endocrinology and Metabolism, vol. 88, no. 12, pp. 5834–5840, 2003.
[4]
D. F. Gunther, I. Bourdeau, L. Matyakhina et al., “Cyclical cushing syndrome presenting in infancy: an early form of primary pigmented nodular adrenocortical disease, or a new entity?” Journal of Clinical Endocrinology and Metabolism, vol. 89, no. 7, pp. 3173–3182, 2004.
[5]
B. Catargi, V. Rigalleau, A. Poussin et al., “Occult Cushing's syndrome in type-2 diabetes,” Journal of Clinical Endocrinology and Metabolism, vol. 88, no. 12, pp. 5808–5813, 2003.
[6]
G. Reimondo, A. Pia, B. Allasino et al., “Screening of Cushing's syndrome in adult patients with newly diagnosed diabetes mellitus,” Clinical Endocrinology, vol. 67, no. 2, pp. 225–229, 2007.
[7]
M. Omura, J. Saito, K. Yamaguchi, Y. Kakuta, and T. Nishikawa, “Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan,” Hypertension Research, vol. 27, no. 3, pp. 193–202, 2004.
[8]
J. Newell-Price, X. Bertagna, A. B. Grossman, and L. K. Nieman, “Cushing's syndrome,” Lancet, vol. 367, no. 9522, pp. 1605–1617, 2006.
[9]
S. K. Baid, D. Rubino, N. Sinaii, S. Ramsey, A. Frank, and L. K. Nieman, “Specificity of screening tests for cushing's syndrome in an overweight and obese population,” Journal of Clinical Endocrinology and Metabolism, vol. 94, no. 10, pp. 3857–3864, 2009.
[10]
O. Tiryakioglu, S. Ugurlu, S. Yalin et al., “Screening for Cushing's syndrome in obese patients,” Clinics, vol. 65, no. 1, pp. 9–13, 2010.
[11]
M. Sahin, L. Kebapcilar, A. Taslipinar et al., “Comparison of 1 mg and 2 mg overnight dexamethasone suppression tests for the screening of Cushing's syndrome in obese patients,” Internal Medicine, vol. 48, no. 1, pp. 33–39, 2009.
[12]
J. W. Findling and H. Raff, “Diagnosis and differential diagnosis of Cushing’s syndrome,” Endocrinology Metabolism Clinics of North America, vol. 30, no. 3, pp. 729–747, 2001.
[13]
D. Jankovi？, P. Wolf, C.-H. Anderwald et al., “Prevalence of endocrine disorders in morbidly obese patients and the effects of bariatric surgery on endocrine and metabolic parameters,” Obesity Surgery, vol. 22, no. 1, pp. 62–69, 2012.
[14]
R. Ness-Abramof, D. Nabriski, C. M. Apovian et al., “Overnight dexamethasone suppression test: a reliable screen for cushing's syndrome in the obese,” Obesity Research, vol. 10, no. 12, pp. 1217–1221, 2002.
[15]
T. Krarup, T. Krarup, and C. Hagen, “Do patients with type 2 diabetes mellitus have an increased prevalence of Cushing's syndrome?” Diabetes/Metabolism Research and Reviews, vol. 28, no. 3, pp. 219–227, 2012.
[16]
L. Guignat and J. Bertherat, “The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline: commentary from a European perspective,” European Journal of Endocrinology, vol. 163, no. 1, pp. 9–13, 2010.
[17]
F. Guaraldi and R. Salvatori, “Cushing syndrome: maybe not so uncommon of an endocrine disease,” Journal of the American Board of Family Medicine, vol. 25, no. 2, pp. 199–208, 2012.
[18]
G. Leibowitz, A. Tsur, S. D. Chayen et al., “Pre-clinical Cushing's syndrome: an unexpected frequent cause of poor glycaemic control in obese diabetic patients,” Clinical Endocrinology, vol. 44, no. 6, pp. 717–722, 1996.
[19]
M. S. S. Caetano, L. Vilar, and C. E. Kater, “Subclinical Cushing's syndrome in populations at risk,” Arquivos Brasileiros de Endocrinologia e Metabologia, vol. 51, no. 8, pp. 1185–1190, 2007.
[20]
M. B. Elamin, M. H. Murad, R. Mullan et al., “Accuracy of diagnostic tests for Cushing's syndrome: a systematic review and metaanalyses,” Journal of Clinical Endocrinology and Metabolism, vol. 93, no. 5, pp. 1553–1562, 2008.
