Contreras L N, Cardoso E, Lozano M P, Pozzo J, Pagano P, Claus-Hermbeg H
Departamento de Endocrinología, Facultad de Medicina, Universidad de Buenos Aires.
Medicina (B Aires). 2000;60(3):326-30.
Preclinical Cushing's syndrome (PCS) is a condition in which cortisol excess is not associated to clinical features of Cushing's syndrome. The aim of this study was to detect PCS in 48 ambulatory overweight type 2 diabetic patients (DM). Controls were 40 normoglycemic obese (Ob) and 36 normo-weight healthy subjects (N). In DM (47/48) total urinary cortisol (UF) levels were similar to those found in Ob and N. Evening urinary cortisol (Spot F) was significantly higher than either Ob (p: 0.0001) or N (p: 0.03), although values did not overcome the upper normal limit (44 ng/mg creatinine). False positive results to the overnight 1 mg dexamethasone suppression test were found in 31% and 22% of DM and Ob, respectively. In a DM female an elevated UF and Spot F associated to absence of cortisol inhibition to the overnight 1 mg dexamethasone suppression test was repeatedly detected. Diagnosis of PCS was performed. Remission of hypercorticism and glycemic control were achieved after pituitary surgery. It would be useful to screen DM patients with poor glycemic control for PCS.
临床前库欣综合征（PCS）是一种皮质醇过量但与库欣综合征临床特征无关的病症。本研究的目的是在48例非卧床超重2型糖尿病患者（DM）中检测PCS。对照组为40例血糖正常的肥胖者（Ob）和36例体重正常的健康受试者（N）。在DM组（47/48）中，尿总皮质醇（UF）水平与Ob组和N组相似。夜间尿皮质醇（即时F）显著高于Ob组（p：0.0001）或N组（p：0.03），尽管其值未超过正常上限（44 ng/mg肌酐）。在DM组和Ob组中，分别有31%和22%的患者对过夜1 mg地塞米松抑制试验出现假阳性结果。在一名DM女性患者中，反复检测到UF和即时F升高，且对过夜1 mg地塞米松抑制试验无皮质醇抑制反应。确诊为PCS。垂体手术后实现了皮质醇增多症的缓解和血糖控制。对血糖控制不佳的DM患者进行PCS筛查将是有益的。
