Dipartimento di Medicina Interna e Specialistica (Di.Bi.Mi.S) Sezione di Endocrinologia e Malattie del Metabolismo Università di Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy.
Eur J Endocrinol. 2013 Dec 21;170(2):311-9. doi: 10.1530/EJE-13-0754. Print 2014 Feb.
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.
糖尿病（DM）是库欣综合征（CS）最常见的并发症之一。本研究旨在确定新诊断 CS 患者中与葡萄糖耐量分类相关的胰岛素敏感性和/或分泌变化。
对 140 例 CS 患者进行的横断面研究。
共纳入 113 名女性（垂体疾病 80 例，肾上腺疾病 33 例，年龄 41.7±15.7 岁）和 27 名男性（垂体疾病 19 例，肾上腺疾病 8 例，年龄 38.1±20.01 岁），根据葡萄糖耐量分为正常糖耐量（CS/NGT）、空腹血糖受损和/或糖耐量受损（CS/前驱糖尿病）和糖尿病（CS/ DM）组。
71 例患者 CS/NGT（49.3%），26 例 CS/前驱糖尿病（18.5%），43 例 CS/ DM（30.8%）。糖尿病家族史（P<0.001）、代谢综合征（P<0.001）、年龄（P<0.001）和腰围（P=0.043）的患病率呈显著递增趋势，而 HOMA-β（P<0.001）和口服葡萄糖处置指数（DIo）（P<0.002）呈显著递减趋势。空腹胰岛素水平、胰岛素曲线下面积（AUCINS）、胰岛素敏感性 Matsuda 指数（ISI-Matsuda）和内脏脂肪指数无显著变化趋势。
葡萄糖耐量受损的特征是β细胞无法通过增加胰岛素分泌来充分补偿胰岛素抵抗。年龄、遗传易感性和生活方式，加上库欣综合征的病程和严重程度，强烈导致了自然史中 CS 患者的葡萄糖耐量受损。对 CS 患者葡萄糖耐量缺陷进行仔细的表型评估，有助于识别那些代谢并发症风险较高的患者。
