Nondiabetic patients with either subclinical Cushing's or nonfunctional adrenal incidentalomas have lower insulin sensitivity than healthy controls: Clinical implications

Ivović, Miomira; Marina, Ljiljana; Vujović, Svetlana; Tancic-Gajic, Milina; Stojanović, Miloš; Radonjić, Nevena V.; Gajić, Milan; Soldatović, Ivan; Micić, Dragan

doi:10.1016/j.metabol.2012.12.006

Cited by 35 publications

(30 citation statements)

References 43 publications

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“…Insulin sensitivity parameters were reduced in both non-functioning adrenal adenoma or in sCS, compared to healthy controls. There was no difference in terms of insulin sensitivity between the two groups of adrenal lesion patients, but subjects with sCS had a significantly higher prevalence of IGT and a higher area under the curve for glucose (19). These data and other studies demonstrate that patients with adrenal incidentaloma, regardless of the functional status, show insulin resistance (20,21,22,23).…”

Section: Gcs and Glucose Metabolismsupporting

confidence: 56%

Metabolic comorbidities in Cushing's syndrome

Ferraú

Korbonits

2015

European Journal of Endocrinology

143

121

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Cushing's syndrome (CS) patients have increased mortality primarily due to cardiovascular events induced by glucocorticoid (GC) excess-related severe metabolic changes. Glucose metabolism abnormalities are common in CS due to increased gluconeogenesis, disruption of insulin signalling with reduced glucose uptake and disposal of glucose and altered insulin secretion, consequent to the combination of GCs effects on liver, muscle, adipose tissue and pancreas. Dyslipidaemia is a frequent feature in CS as a result of GC-induced increased lipolysis, lipid mobilisation, liponeogenesis and adipogenesis. Protein metabolism is severely affected by GC excess via complex direct and indirect stimulation of protein breakdown and inhibition of protein synthesis, which can lead to muscle loss. CS patients show changes in body composition, with fat redistribution resulting in accumulation of central adipose tissue. Metabolic changes, altered adipokine release, GC-induced heart and vasculature abnormalities, hypertension and atherosclerosis contribute to the increased cardiovascular morbidity and mortality. In paediatric CS patients, the interplay between GC and the GH/IGF1 axis affects growth and body composition, while in adults it further contributes to the metabolic derangement. GC excess has a myriad of deleterious effects and here we attempt to summarise the metabolic comorbidities related to CS and their management in the perspective of reducing the cardiovascular risk and mortality overall.

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Section: Gcs and Glucose Metabolismsupporting

confidence: 56%

Metabolic comorbidities in Cushing's syndrome

Ferraú

Korbonits

2015

European Journal of Endocrinology

143

121

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“…Two recent reports showed increasing degrees of alterations of indices of insulin resistance in controls, patients with nonfunctioning adrenal adenomas and SH (24,25). T2D occurs in roughly one third of patients with SH.…”

Section: Overview Of Associated Co-morbiditiesmentioning

confidence: 97%

Subclinical hypercortisolism: a state, a syndrome, or a disease?

Dalmazi¹,

Pasquali²,

Beuschlein³

et al. 2015

European Journal of Endocrinology

114

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Subclinical hypercortisolism (SH), defined as alterations of the hypothalamus-pituitary-adrenal axis in the absence of clinical signs or symptoms related to cortisol secretion, is a common finding in patients with adrenal incidentalomas. The clinical correlates of this pathological condition have become clearer over the last few years. The aim of this review is to summarize the co-morbidities and the clinical outcomes of patients with SH. According to the analysis of the results of the studies published within the last 15 years, hypertension and type 2 diabetes are a common finding in patients with SH, occurring roughly in 2/3 and 1/3 of the patients respectively. Moreover, several additional cardiovascular and metabolic complications, like endothelial damage, increased visceral fat accumulation and impaired lipid metabolism have been shown to increase the cardiovascular risk of those patients. Accordingly, recent independent reports investigating the natural history of the disease in a long-term follow-up setting have shown that patients with SH have a higher incidence of cardiovascular events and related mortality. Moreover, longitudinal studies have also shown increased incidence of osteoporotic vertebral fractures. Future research is needed to improve the diagnostic performance of hormonal tests, by assessment of the complete steroid profile with more accurate assays, and to define the efficacy of surgical vs medical treatment in a randomizedcontrolled setting.

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“…The prevalence of subclinical hypercortisolism has been estimated to be 0.2-2.0% in the adult population and thereby represents a key suspect for developing MeS [75]. Still, and despite the correlation of subclinical hypercortisolism with visceral obesity [76], hypertension [77], IR [78], and increased cardiovascular risk [79], the clinical significance in MeS still remains unclear.…”

Section: Endocrine Systemmentioning

confidence: 99%

Clinical Scenario of the Metabolic Syndrome

et al. 2016

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The term metabolic syndrome (MeS) refers to a cluster of associated symptoms composed of impaired fasting glucose, abdominal obesity, hypertension, and dyslipidemia. MeS is associated with an increased risk of cardiovascular and diabetes-associated morbidity and mortality. The increased amount of visceral fat together with a chronic inflammatory state predisposes to the development of arteriosclerosis. Furthermore, insulin resistance (IR) and dyslipidemia are associated with fatty liver disease. In addition, MeS is linked to non-cardiovascular diseases such as cancer as well as psychiatric or endocrine disorders. Here, we discuss the clinical impact of MeS in cardiovascular and non-cardiovascular diseases to highlight the importance of prevention, early diagnosis, and multifactorial treatment of high-risk individuals.

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Nondiabetic patients with either subclinical Cushing's or nonfunctional adrenal incidentalomas have lower insulin sensitivity than healthy controls: Clinical implications

Cited by 35 publications

References 43 publications

Metabolic comorbidities in Cushing's syndrome

Metabolic comorbidities in Cushing's syndrome

Subclinical hypercortisolism: a state, a syndrome, or a disease?

Clinical Scenario of the Metabolic Syndrome

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