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Is diabetes in Cushing's syndrome only a consequence of hypercortisolism?
[cushing syndrome]
Diabetes
mellitus
(
DM
)
is
one
of
the
most
frequent
complications
of
Cushing
's
syndrome
(
CS
)
.
The
aim
of
this
study
was
to
define
the
changes
in
insulin
sensitivity
and
/
or
secretion
in
relation
to
glucose
tolerance
categories
in
newly
diagnosed
CS
patients
.
Cross-sectional
study
on
140
patients
with
CS
.
A
total
of
113
women
(
80
with
pituitary
disease
and
33
with
adrenal
disease
,
aged
41
.
7
±
15
.
7
years
)
and
27
men
(
19
with
pituitary
disease
and
eight
with
adrenal
disease
,
aged
38
.
1
±
20
.
01
years
)
at
diagnosis
were
divided
according
to
glucose
tolerance
into
normal
glucose
tolerance
(
CS
/
NGT
)
,
impaired
fasting
glucose
and
/
or
impaired
glucose
tolerance
(
CS
/
prediabetes
)
,
and
diabetes
(
CS
/
DM
)
groups
.
Seventy
-
one
patients
had
CS
/
NGT
(
49
.
3
%
)
,
26
(
18
.
5
%
)
had
CS
/
prediabetes
and
43
(
30
.
8
%
)
had
CS
/
DM
.
Significant
increasing
trends
in
the
prevalence
of
family
history
of
diabetes
(
P
<
0
.
001
)
,
metabolic
syndrome
(
P
<
0
.
001
)
,
age
(
P
<
0
.
001
)
and
waist
circumference
(
P
=
0
.
043
)
and
decreasing
trends
in
HOMA-β
(
P
<
0
.
001
)
and
oral
disposition
index
(
DIo
)
(
P
<
0
.
002
)
were
observed
among
the
groups
.
No
significant
trends
in
fasting
insulin
levels
,
area
under
the
curve
for
insulin
(
AUCINS
)
,
Matsuda
index
of
insulin
sensitivity
(
ISI-Matsuda
)
and
visceral
adiposity
index
were
detected
.
Impairment
of
glucose
tolerance
is
characterized
by
the
inability
of
β-cells
to
adequately
compensate
for
insulin
resistance
through
increased
insulin
secretion
.
Age
,
genetic
predisposition
and
lifestyle
,
in
combination
with
the
duration
and
degree
of
hypercortisolism
,
strongly
contribute
to
the
impairment
of
glucose
tolerance
in
patients
with
a
natural
history
of
CS
.
A
careful
phenotypic
evaluation
of
glucose
tolerance
defects
in
patients
with
CS
proves
useful
for
the
identification
of
those
at
a
high
risk
of
metabolic
complications
.
Diseases
Validation
Diseases presenting
"diabetes mellitus"
symptom
acute rheumatic fever
adrenal incidentaloma
adrenomyeloneuropathy
allergic bronchopulmonary aspergillosis
alpha-thalassemia
child syndrome
cholangiocarcinoma
cohen syndrome
congenital adrenal hyperplasia
congenital toxoplasmosis
cowden syndrome
cushing syndrome
cystinuria
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
fabry disease
familial hypocalciuric hypercalcemia
malignant atrophic papulosis
neuralgic amyotrophy
pyomyositis
sneddon syndrome
typhoid
werner syndrome
wolf-hirschhorn syndrome
This symptom has already been validated