Endocrine Abstracts

Introduction: Endogenous Cushing’s syndrome (CS) is a rare disease associated with severe morbidity and increased mortality if untreated. Glucose metabolism is significantly altered in hypercortisolism.

Objective: To retrospectively analyse the clinical presentation of a cohort of patients with endogenous CS and study the frequency of glucose metabolism abnormalities as opposed to other clinical signs and symptoms.

Material and methods: We retrospectively analysed the clinical presentation of 68 cases diagnosed with endogenous Cushing’s syndrome followed-up in our institution.

Results: There were 57 women, 11 men aged 18–74 years-old of which 38 had Cushing’s disease (CD) and 30 had adrenal CS. Patients with CD were significantly younger (40.42 vs 52.1 years, P 0.000). The most frequent initial signs/symptoms were central obesity (55 cases, 80.88%), purple striae (28 cases, 41.1%), hirsutism in 23/55 women (41.81%), secondary arterial hypertension (27 cases, 39.7%), secondary diabetes mellitus (24 cases, 35.29%). Four cases (5.8%) had impaired glucose tolerance (IGT, defined as per current guidelines). 33% of cases had symptoms of hypogonadism and 25% complained of proximal myopathy. Despite the fact that hypercortisolism was equally severe in CS and CD patients, proximal myopathy, secondary hypertension and glycemic abnormalities were more frequent in cases with adrenal CS compared to those with CD. (P=0.011, 0.006 and 0.024, respectively).

Conclusions: Secondary diabetes mellitus is present in a significant percentage of CS patients at the time of diagnosis. Although it is not recommended to screen all patients with DM for hypercortisolism, the coexistence of other clinical symptoms and signs (both nonspecific (central obesity, edema, arterial hypertension) and more suggestive of the disease (purple striae, proximal myopathy)) in a patient with recent-onset diabetes mellitus should prompt a thorough investigation for CS (whose warly diagnosis will lead to significant decrease in morbidity and mortality).