Disorders of carbohydrate metabolism in Cushing‘s syndrome

Authors: Michal Kršek
Authors‘ workplace: III. interní klinika - klinika endokrinologie a metabolizmu1. LF UK a Všeobecná fakultní nemocnice, přednosta prof. MUDr. Štěpán Svačina, DrSc., MBA, Praha, Česká republika
Published in: Forum Diab 2014; 3(3): 123-127
Category: Foreign Post


Cushing‘s syndrome (CS) is a rare condition associated with higher secretion of cortisol which causes increased morbidity and mortality, especially cardiovascular. The increased cardiovascular morbidity and mortality is mainly a consequence of metabolic changes which are similar to metabolic syndrome. An important clinical sign of the CS is impaired glucose tolerance presented in more than half of patients. The etiopathogenesis of that is cortisol effect on the tissues and organs resulting in insulin resistance. An active screening is crucial for prognosis of patients with impaired glucose metabolism as well as early treatment and strict diabetic control. Some of these changes persist after CS healing, therefore, for better prognosis it is necessary consistently to search for these patients and intervene if needed. The article presents a review of current knowledge about these changes especially focused on diabetes mellitus in CS, its etiopathogenesis, clinical aspects and treatment.

Key words:
Cushing‘s syndrome – diabetes mellitus – metabolic disorders – pathogenesis


1. Cushing H. The basophil adenomas of the pituitary body and their clinical manifestations (pituitary basophilism). Bull Johns Hopkins Hosp 1932; 50: 137–195.

2. Ross EJ, Linch DC. Cushing’s syndrome-Killing disease: Discriminatory value of signs and symptoms aiding early diagnosis. Lancet 1982 2(8299): 646–649.

3. Newell-Price J. Diagnosis/differential diagnosis of Cushing‘ s syndrome: a review of best practice. Best Pract Res Clin Endocrinol Metab 2009; 23(Suppl 1): S5-S14.

4. Kršek M, Čáp J, Hána V et al. Doporučení České endokrinologické společnosti pro léčbu Cushingova syndromu v dospělosti. Diabetologie, metabolismus, endokrinologie, výživa 2013; 16(1): 63–71.

5. Faggiano A, Pivonello R, Spiezia S et al. Cardiovascular risk factors and common carotid artery calibre and stiffness in patients with Cushing’s disease during active disease and 1 year after disease remission. J Clin Endocrinol Metab 2003; 88(6): 2527–2533.

6. Pivonello R, Faggiano A, Lombardi G et al. The metabolic syndrome and cardiovascular risk in Cushing’s syndrome. Endocrinol Metab Clin North Am 2005; 34(2): 327–339.

7. Newell-Price J, Bertagna X, Grossman AB et al. Cushing’s syndrome. Lancet 2006; 367(9522): 1605–1617.

8. Burt MG, Gibney J, Ho KK. Characterization of the metabolic phenotypes of Cushing’s syndrome and growth hormone deficiency: a study of body composition and energy metabolism. Clin Endocrinol (Oxf) 2006; 64(4): 436–443.

9. Tataranni PA, Larson DE, Snitker S et al. Effects of glucocorticoids on energy metabolism and food intake in humans. Am J Physiol 1996; 271(2 Pt 1) E317-E325. Dostupné z http: <http://ajpendo.physiology.org/content/271/2/E317>.

10. Ahdjoudj S, Lasmoles F, Oyajobi BO et al. Reciprocal control of osteoblast/chondroblast and osteoblast/adipocyte differentiation of multipotential clonal human marrow stromal F/STRO-1(+) cells. J Cell Biochem 2001; 81(1): 23–38.

11. Taskinen MR, Nikkila EA, Pelkonen R et al. Plasma lipoproteins, lipolytic enzymes, and very low density lipoprotein triglyceride turnover in Cushing’s syndrome. J Clin Endocrinol Metab 1983; 57(3): 619–626.

12. Kola B, Christ-Crain M, Lolli F et al. Changes in adenosine 5´-monophosphate-activated protein kinase as a mechanism of visceral obesity in Cushing’s syndrome. J Clin Endocrinol Metab 2008; 93(12): 4969–4973.

13. Qi D, Rodrigues B. Glucocorticoids produce whole body insulin resistance with changes in cardiac metabolism. Am J Physiol Endocrinol Metab 2007; 292(3): E654-E667. Dostupné z DOI: <http://doi:10.1152/ajpendo.00453.2006>.

14. van Raalte DH, Ouwens DM, Diamant M. Novel insights into glucocorticoid-mediated diabetogenic effects: towards expansion of therapeutic options? Eur J Clin Invest 2009; 39(2): 81–93.

15. Hansen KB, Vilsbøll T, Bagger JI et al. Reduced glucose tolerance and insulin resistance induced by steroid treatment, relative physical inactivity and high-calorie diet impairs the incretin effect in healthy subjects. J Clin Endocrinol Metab 2010; 95(7): 3309–3317.

16. Pivonello R, De Leo M, Vitale P et al. Pathophysiology of diabetes mellitus in Cushing’s syndrome. Neuroendocrinology 2010; 92(Suppl 1): 77–81.

17. Mazziotti G, Gazzaruso C, Giustina A. Diabetes in Cushing syndrome: basic and clinical aspects. Trends in Endocrinology and Metabolism 2011; 22(12): 499–506.

18. Mancini T, Kola B, Mantero F et al. High cardiovascular risk in patients with Cushing’s syndrome according to 1999 WHO/ISH guidelines. Clin Endocrinol 2004; 61(6): 768–777.

19. Muscogiuri G, Sorice GP, Prioletta A et al. The size of adrenal incidentalomas correlates with insulin resistence. Is there a caue-effect relationship? Clin Endocrinol 2011; 74(3): 300–305.

20. Morelli V, Masserini B, Salcuni AS et al. Subclinical hypercortisolism: correlation between biochemical diagnostic criteria and clinical aspects. Clin Endocrinol 2010; 73(2): 161–166.

21. Munir A, Newell-Price J. Management of diabetes mellitus in Cushing’s syndrome. Neuroendocrinology 2010; 92(Suppl 1): 82–85.

22. Colao A, Pivonello R, Spiezia S et al. Persistence of increased cardiovascular risk in patients with Cushing’s disease after five years of successful cure. J Clin Endocrinol Metab 1999; 84(8): 2664–2672.

23. Colao A, De Block C, Gaztambide MS et al. Managing hyperglycemia in patients with Cushing’s disease treated with pasireotide: medical expert recommendations. Pituitary 2014; 17(2): 180–186.

24. Clore JN, Thurby-Hay L. Glucocorticoid-induced hyperglycemia. Endocr Pract 2009; 15(5): 469–474.

Diabetology Endocrinology Internal medicine
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