Who and how to screen for endogenous hypercortisolism in type 2 diabetes mellitus or obesity.

IF 5.4 2区 医学 Q1 Medicine Journal of Endocrinological Investigation Pub Date : 2024-10-01 DOI:10.1007/s40618-024-02455-7
Valentina Guarnotta, Carla Giordano, Giuseppe Reimondo
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Abstract

Purpose: The current review aims to summarize and discuss the prevalence of confirmed hypercortisolism in patients with diabetes mellitus or obesity, analysing the screening tests used and their accuracy, in order to better identify whether patients with diabetes mellitus and obesity should be screened for Cushing's syndrome (CS) and how.

Methods: A narrative review was performed including publications focusing on the current knowledge on prevalence of confirmed hypercortisolism in patients with type 2 diabetes mellitus (T2DM) or obesity and on screening tests used to detect CS.

Results: The studies reviewed suggest that the prevalence of CS in patients with T2DM is variable, ranging from 0.6 to 9.3%. The most used screening test is the overnight cortisol after 1 mg of dexamethasone suppression test (DST), with a false positive rate ranging from 3.7 to 21%. The prevalence of CS among obese patients is generally about 1%, except for two studies which reported higher prevalence. For obese patients, 1 mg DST and late-night salivary cortisol are the most accurate screening tests for CS.

Conclusions: Clinical expertise remains the mainstay to identify which subjects should be screened for CS. The evaluation of the clinical stigmata of CS and the combination with clinical comorbidities typical of CS are the stronger predictors of CS. In addition, we could hypothesize that in patients with T2DM, overnight 1 mg DST is the more accurate screening test for CS. By contrast, in patients with obesity both LNSC and overnight 1 mg DST could be equally used for the screening of hypercortisolism.

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谁以及如何筛查 2 型糖尿病或肥胖症患者的内源性皮质醇增多症。
目的:本综述旨在总结和讨论糖尿病或肥胖症患者确诊皮质醇增多症的患病率,分析所使用的筛查测试及其准确性,以便更好地确定糖尿病和肥胖症患者是否应筛查库欣综合征(CS)以及如何筛查:方法:我们对相关出版物进行了叙述性综述,内容主要涉及目前对2型糖尿病(T2DM)或肥胖症患者确诊皮质醇过多症患病率的了解,以及用于检测库欣综合征的筛查试验:综述的研究表明,T2DM 患者中 CS 的患病率各不相同,从 0.6% 到 9.3% 不等。最常用的筛查试验是 1 毫克地塞米松抑制试验(DST)后的过夜皮质醇,假阳性率为 3.7% 至 21%。肥胖患者的 CS 患病率一般约为 1%,只有两项研究报告了更高的患病率。对于肥胖患者,1 毫克 DST 和深夜唾液皮质醇是最准确的 CS 筛查测试:结论:临床专业知识仍是确定哪些受试者应接受 CS 筛查的主要依据。结论:临床专业知识仍是确定哪些受试者应接受 CS 筛查的主要依据,而对 CS 临床症状的评估以及与 CS 典型临床合并症的结合则是预测 CS 的更有力因素。此外,我们还可以假设,在 T2DM 患者中,隔夜 1 毫克 DST 是更准确的 CS 筛查试验。相比之下,在肥胖症患者中,LNSC 和过夜 1 毫克 DST 同样可用于筛查皮质醇过多症。
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来源期刊
Journal of Endocrinological Investigation
Journal of Endocrinological Investigation ENDOCRINOLOGY & METABOLISM-
CiteScore
8.10
自引率
7.40%
发文量
242
期刊介绍: The Journal of Endocrinological Investigation is a well-established, e-only endocrine journal founded 36 years ago in 1978. It is the official journal of the Italian Society of Endocrinology (SIE), established in 1964. Other Italian societies in the endocrinology and metabolism field are affiliated to the journal: Italian Society of Andrology and Sexual Medicine, Italian Society of Obesity, Italian Society of Pediatric Endocrinology and Diabetology, Clinical Endocrinologists’ Association, Thyroid Association, Endocrine Surgical Units Association, Italian Society of Pharmacology.
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