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Screening of Cushing's syndrome in adult patients with newly diagnosed diabetes mellitus


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Reimondo G, Pia A, Allasino B, Tassone F, Bovio S, Borretta G, Angeli A, Terzolo M:

 

Screening of Cushing's syndrome in adult patients with newly diagnosed diabetes mellitus

Pendergrass, Merri. "Reimondo G, Pia A, Allasino B, Tassone F, Bovio S, Borretta G, Angeli A, Terzolo M: Screening of Cushing's syndrome in adult patients with newly diagnosed diabetes mellitus.(Key Global Literature). ." Diabetes Care. 30.9 (Sept 2007): 2420(1)

 

Full Text:COPYRIGHT 2007 American Diabetes Association

Reimondo G, Pia A, Allasino B, Tassone F, Bovio S, Borretta G, Angeli A, Terzolo M: Screening of Cushing's syndrome in adult patients with newly diagnosed diabetes mellitus. Clin Endocrinol (Oxf) 2007 Jun 4; [Epub ahead of print]

 

Findings. One hundred consecutive diabetic patients diagnosed between 1 June 2003 and 30 May 2004 were prospectively screened for the presence of Cushing's syndrome. Screening was performed using the overnight 1-mg dexamethasone suppression test (DST). Testing took place after recovery from any acute concomitant illnesses and attainment of satisfactory glycemic control. The threshold of adequate suppression of the plasma cortisol level after DST was set at 110 nmol/1. Five patients failed to suppress cortisol after DST and underwent a repeated DST and a confirmatory standard 2-day, 2-mg DST 3-6 months after the baseline evaluation. Four of these patients normally suppressed cortisol levels

 

Significance. There are well-recognized similarities between Cushing's syndrome and type 2 diabetes. Both are characterized by central obesity, hypertension, insulin resistance, glucose intolerance, and dyslipidemia. Furthermore, increasing evidence suggests patients with diabetes may have impairments in the hypothalamic-pituitary-adrenal axis. This small study does not suggest that there is significant incidence of undiagnosed Cushing's syndrome in patients with type 2 diabetes.

 

Impact. Although it is tempting for clinicians to consider screening for Cushing's syndrome in patients with type 2 diabetes, that practice is generally discouraged. Cushing's syndrome is rare, type 2 diabetes is common, screening tests for Cushing's syndrome are cumbersome, and the risk-benefit relationship of screening is unknown. Screening should not be done routinely but should be reserved for patients in whom there is strong clinical suspicion. [Robin interjects: ARGHHHHH!!!!!!!!!!!! This is what we fight with the medical community!!!!!!!!!!!!!! ARGH ARGH ARGH ARGH ARGH!!!!!!!!!!!!!!!!!!]

 

Merri Pendergrass, MD, PHD

 

From the Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts. E-mail: mpendergrass@partners.org.

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AAARGH is right! If you consider how many of us suppressed on dex tests and were still proven to have Cushings you can see the fallacies in this study!

 

I just went to my PCP today and we were talking about my "unremarkable" MRI and other things. He said "this is why we really should not depend on any particular test or imaging study -- we need to use our clinical experience, instinct and observation skills as adjuncts. After all, if it looks like a duck and quacks like a duck it's probably not a cat!" I could have kissed him.

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ARGH is right!

 

Here's Dr. Pendergrass' website... http://www.brighamandwomens.org/mdSearch/M...l.aspx?MPR=7669

 

Why don't we all send her a little note suggesting to her that she might want to let her patients decide what tests are too "cumbersome", that medicine is still being practiced because it's not perfected and that if they ever find that cushing's is not rare but rarely diagnosed that we'll all happily bring her a hat to eat.

 

Ami

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When you consider that Italian researchers found that 10% of type 2 DMs had occult Cushing's and that they also represent those in hospital with the worst complications, her conclusion is heinous.

 

The ADA is consistently on the side of turf protection (they deny that metabolic syndrome exists, because that splits their turf with the AHA), they recommend eating mostly starches and even sugar (their biggest sponsors manufacture these and also drugs to control the results).

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I agree, AARRRRRGH!!! I s'pose the patient who was found to have Cushings, counted themselves as lucky---'cause it was more than "chance" that identified things.

 

PS---If a disease is thought to be rare or hard to diagnose, does that mean that doctors are any less responsible??? Kind of reminds me of someone making excuses for themselves...

 

Yikes!!!

 

I was really hoping to hear that they thought that screening for Cushings was a no-brainer. Can you imagine how many people would get screened??? It would really catch a lot of "rare" diseases if you ask me...

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