Glucose Tolerance and Endometrial Carcinoma

Abstract

The concept that the triad of diabetes mellitus, obesity, and hypertension is of etiologic and diagnostic significance in endometrial carcinoma was tested in 55 patients with endometrial carcinoma and 114 control patients. Factors which might influence glucose tolerance such as age, parity, obesity, hypertension, family history of diabetes, and anterior pituitary function were evaluated. Both groups consisted of patients who had postmenopausal bleeding and were divided into those with endometrial carcinoma and those with neither endometrial carcinoma nor hyperplasia. Abnormal glucose metabolism and sustained arterial hypertension were no more frequent in patients with endometrial carcinoma than in the controls. There appeared to be no association between increased parity and decreased glucose tolerance nor between the degree of obesity and decreased glucose tolerance. The carcinoma group was significantly more obese and less parous than the control group.The literature dealing with the epidemiology of endometrial carcinoma contains many refer¬ ences to the triad of diabetes mellitus, obesity, and hypertension. It has been postulated that the associ¬ ated triad characteristic of this ma¬ lignancy is of both etiologic and diagnostic significance and that an underlying endocrinopathy is re¬ sponsible not only for the triad but also for the carcinoma itself. A sur¬ vey of the literature, however, es¬ pecially in regard to the frequency of diabetes in patients with endo¬ metrial carcinoma, leads to no clear conclusions (Table 1 and 2). No study has taken into account many of the factors that influence glucose tolerance, such as age, parity, obes¬ ity, hypertension, family history of diabetes, and anterior pituitary func¬ tion. The purpose of this paper is to report observations on these factors and to assess their relationship to glucose tolerance in patients with endometrial carcinoma and in an ap¬ propriately matched control group. Materials and MethodsFifty-five patients with endometrial carcinoma and 114 control patients par¬ ticipated in the study. All were referred to the University of Iowa Hospitals in the years 1963 to 1966. The presence of the malignancy was documented by bi¬ opsy or curettage. No patient received therapy before the endocrine evalua¬ tion. All were patients of the Gynecology Service and participated in a comprehensive investigation of the en¬ docrine factors in endometrial carci¬ noma. This paper represents one phase of the larger study.1 Control Group.-In view of the re¬ ported effects of age, socioeconomic status, obesity, hypertension, and family history of diabetes on glucose tolerance, it is of the utmost importance to have an unbiased control group which is similar to the study group in these fac¬ tors, and yet which is not selected on