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Screening for Cushing’s syndrome: Is it worthwhile?

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Abstract

Introduction

Cushing’s syndrome (CS) is a rare disease characterized by a collection of signs and symptoms, also common in the general population without elevated cortisol secretion. During the last years more patients with CS are identified earlier and with milder disease. Many of these patients are diagnosed during screening efforts performed for certain or isolated complaints like weight gain, diabetes mellitus (DM), hypertension, osteoporosis, elevated white blood cell counts and more.

Methods

In this review article the most popular screening test performed in the studies cited was the 1-mg dexamethasone suppression test.

Conclusions

Cushing is not frequent enough to support the use of routine screening in patients with morbid obesity and type 2 DM. Also only 1 % of hypertensive patients have secondary hypertension due to CS. However, screening should be considered in young patients with resistant DM and/or hypertension. Among patients with osteoporosis and vertebral fractures up to 5 % were diagnosed with subclinical hypercortisolism; most of these had adrenal adenoma. Screening for CS is important in subjects with adrenal incidentaloma, and many studies show a high prevalence (~10 %) of Cushing or subclinical CS in these patients.

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References

  1. Newell-Price J, Bertagna X, Grossman AB, Nieman LK (2006) Cushing’s syndrome. Lancet 367:1605–1617

    Article  CAS  PubMed  Google Scholar 

  2. Nieman LK, Biller BM, Findling JW, Newell-Price J, Savage MO, Stewart PM, Montori VM (2008) The diagnosis of Cushing’s syndrome: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 93:1526–1540

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Mantero F, Terzolo M, Arnaldi G, Osella G, Masini AM, Alì A, Giovagnetti M, Opocher G, Angeli A (2000) A survey on adrenal incidentaloma in Italy. Study group on adrenal tumors of the Italian society of endocrinology. J Clin Endocrinol Metab 85:637–644

    CAS  PubMed  Google Scholar 

  4. Morelli V, Reimondo G, Giordano R, Della Casa S, Policola C, Palmieri S, Salcuni AS, Dolci A, Mendola M, Arosio M, Ambrosi B, Scillitani A, Ghigo E, Beck-Peccoz P, Terzolo M, Chiodini I (2014) Long-term follow-up in adrenal incidentalomas: an Italian multicenter study. J Clin Endocrinol Metab 99:827–834

    CAS  PubMed  Google Scholar 

  5. Ness-Abramof R, Nabriski D, Apovian CM, Niven M, Weiss E, Shapiro MS, Shenkman L (2002) Overnight dexamethasone suppression test: a reliable screen for Cushing’s syndrome in the obese. Obes Res 10:1217–1221

    Article  CAS  PubMed  Google Scholar 

  6. Tiryakioglu O, Ugurlu S, Yalin S, Yirmibescik S, Caglar E, Yetkin DO, Kadioglu P (2010) Screening for Cushing’s syndrome in obese patients. Clinics (Sao Paulo) 65:9–13

    Article  Google Scholar 

  7. Baid SK, Rubino D, Sinaii N, Ramsey S, Frank A, Nieman LK (2009) Specificity of screening tests for Cushing’s syndrome in an overweight and obese population. J Clin Endocrinol Metab 94:3857–3864

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Fierabracci P, Pinchera A, Martinelli S, Scartabelli G, Salvetti G, Giannetti M, Pucci A, Galli G, Ricco I, Querci G, Rago T, Di Salvo C, Anselmino M, Vitti P, Santini F (2011) Prevalence of endocrine diseases in morbidly obese patients scheduled for bariatric surgery: beyond diabetes. Obes Surg 21:54–60

    Article  PubMed  Google Scholar 

  9. Janković D, Wolf P, Anderwald CH, Winhofer Y, Promintzer-Schifferl M, Hofer A, Langer F, Prager G, Ludvik B, Gessl A, Luger A, Krebs M (2012) Prevalence of endocrine disorders in morbidly obese patients and the effects of bariatric surgery on endocrine and metabolic parameters. Obes Surg 22:62–69

    Article  PubMed  Google Scholar 

  10. Leibowitz G, Tsur A, Chayen SD, Salameh M, Raz I, Cerasi E, Gross DJ (1996) Pre-clinical Cushing’s syndrome: an unexpected frequent cause of poor glycaemic control in obese diabetic patients. Clin Endocrinol (Oxf) 44:717–722

    Article  CAS  Google Scholar 

  11. Chiodini I, Torlontano M, Scillitani A, Arosio M, Bacci S, Di Lembo S, Epaminonda P, Augello G, Enrini R, Ambrosi B, Adda G, Trischitta V (2005) Association of subclinical hypercortisolism with type 2 diabetes mellitus: a case–control study in hospitalized patients. Eur J Endocrinol 153:837–844

    Article  CAS  PubMed  Google Scholar 

  12. Contreras LN, Cardoso E, Lozano MP, Pozzo J, Pagano P, Claus-Hermbeg H (2000) Detection of preclinical Cushing’s syndrome in overweight type 2 diabetic patients. Medicina (B Aires) 60:326–330

    CAS  Google Scholar 

  13. Catargi B, Rigalleau V, Poussin A, Ronci-Chaix N, Bex V, Vergnot V, Gin H, Roger P, Tabarin A (2003) Occult Cushing’s syndrome in type-2 diabetes. J Clin Endocrinol Metab 88:5808–5813

    Article  CAS  PubMed  Google Scholar 

  14. Reimondo G, Pia A, Allasino B, Tassone F, Bovio S, Borretta G, Angeli A, Terzolo M (2007) Screening of Cushing’s syndrome in adult patients with newly diagnosed diabetes mellitus. Clin Endocrinol (Oxf) 67:225–229

    Article  CAS  Google Scholar 

  15. Mullan K, Black N, Thiraviaraj A, Bell PM, Burgess C, Hunter SJ, McCance DR, Leslie H, Sheridan B, Atkinson AB (2010) Is there value in routine screening for Cushing’s syndrome in patients with diabetes? J Clin Endocrinol Metab 95:2262–2265

    Article  CAS  PubMed  Google Scholar 

  16. Gagliardi L, Chapman IM, O’Loughlin P, Torpy DJ (2010) Screening for subclinical Cushing’s syndrome in type 2 diabetes mellitus: low false-positive rates with nocturnal salivary cortisol. Horm Metab Res 42:280–284

    Article  CAS  PubMed  Google Scholar 

  17. Terzolo M, Reimondo G, Chiodini I et al (2012) Screening of Cushing’s syndrome in outpatients with type 2 diabetes: results of a prospective multicentric study in Italy. J Clin Endocrinol Metab 97:3467–3475

    Article  CAS  PubMed  Google Scholar 

  18. Anderson GH Jr, Blakeman N, Streeten DH (1994) The effect of age on prevalence of secondary forms of hypertension in 4429 consecutively referred patients. J Hypertens 12:609–615

    Article  PubMed  Google Scholar 

  19. Omura M, Saito J, Yamaguchi K, Kakuta Y, Nishikawa T (2004) Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan. Hypertens Res 27:193–202

    Article  PubMed  Google Scholar 

  20. Martins LC, Conceição FL, Muxfeldt ES, Salles GF (2012) Prevalence and associated factors of subclinical hypercortisolism in patients with resistant hypertension. J Hypertens 30:967–973

    Article  CAS  PubMed  Google Scholar 

  21. Trifanescu R, Carsote M, Caragheorgheopol A, Hortopan D, Dumitrascu A, Dobrescu M, Poiana C (2013) Screening for secondary endocrine hypertension in young patients. Maedica (Buchar) 8:108–115

    Google Scholar 

  22. van der Eerden AW, den Heijer M, Oyen WJ, Hermus AR (2007) Cushing’s syndrome and bone mineral density: lowest Z scores in young patients. Neth J Med 65:137–141

    PubMed  Google Scholar 

  23. Mancini T, Doga M, Mazziotti G, Giustina A (2004) Cushing’s syndrome and bone. Pituitary 7:249–252

    Article  PubMed  Google Scholar 

  24. Chiodini I, Mascia ML, Muscarella S, Battista C, Minisola S, Arosio M, Santini SA, Guglielmi G, Carnevale V, Scillitani A (2007) Subclinical hypercortisolism among outpatients referred for osteoporosis. Ann Intern Med 147:541–548

    Article  PubMed  Google Scholar 

  25. Kann P, Laudes M, Piepkorn B, Heintz A, Beyer J (2001) Suppressed levels of serum cortisol following high-dose oral dexamethasone administration differ between healthy postmenopausal females and patients with established primary vertebral osteoporosis. Clin Rheumatol 20:25–29

    Article  CAS  PubMed  Google Scholar 

  26. Tsvetov G, Shimon I, Benbassat C (2007) Adrenal incidentaloma: clinical characteristics and comparison between patients with and without extra adrenal malignancy. J Endocrinol Invest 30:647–652

    Article  CAS  PubMed  Google Scholar 

  27. Comlekci A, Yener S, Ertilav S, Secil M, Akinci B, Demir T, Kebapcilar L, Bayraktar F, Yesil S, Eraslan S (2010) Adrenal incidentaloma, clinical, metabolic, follow-up aspects: single centre experience. Endocrine 37:40–46

    Article  CAS  PubMed  Google Scholar 

  28. Olsen H, Nordenström E, Bergenfelz A, Nyman U, Valdemarsson S, Palmqvist E (2012) Subclinical hypercortisolism and CT appearance in adrenal incidentalomas: a multicenter study from Southern Sweden. Endocrine 42:164–173

    Article  CAS  PubMed  Google Scholar 

  29. Kim J, Bae KH, Choi YK, Jeong JY, Park KG, Kim JG, Lee IK (2013) Clinical characteristics for 348 patients with adrenal incidentaloma. Endocrinol Metab (Seoul) 28:20–25

    Article  Google Scholar 

  30. Cho YY, Suh S, Joung JY, Jeong H, Je D, Yoo H, Park TK, Min YK, Kim KW, Kim JH (2013) Clinical characteristics and follow-up of Korean patients with adrenal incidentalomas. Korean J Intern Med 28:557–564

    Article  PubMed Central  PubMed  Google Scholar 

  31. Terzolo M, Stigliano A, Chiodini I, Loli P, Furlani L, Arnaldi G, Reimondo G, Pia A, Toscano V, Zini M, Borretta G, Papini E, Garofalo P, Allolio B, Dupas B, Mantero F, Tabarin A, Italian Association of Clinical Endocrinologists (2011) AME position statement on adrenal incidentaloma. Eur J Endocrinol 164:851–870

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This review did not receive any specific Grant from any funding agency in the public, commercial or not-for-profit sector.

Conflict of interest

The author declares that he has no conflict of interest.

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Authors and Affiliations

  1. Rabin Medical Center, Institute of Endocrinology and Metabolism, Beilinson Hospital, 49100, Petach Tikva, Israel

    Ilan Shimon

  2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Ilan Shimon

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  1. Ilan Shimon
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Correspondence to Ilan Shimon.

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Shimon, I. Screening for Cushing’s syndrome: Is it worthwhile?. Pituitary 18, 201–205 (2015). https://doi.org/10.1007/s11102-015-0634-9

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  • DOI: https://doi.org/10.1007/s11102-015-0634-9

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