A majority of patients with T2D have an adrenal source of hypercortisolism1-4
Adrenal source of hypercortisolism
INITIAL SCREENING
CONSIDER THE SUSPECTED SOURCE OF EXCESS CORTISOL
A significant proportion of patients with hypercortisolism presenting initially with type 2 diabetes (T2D) will have an adrenal source1-4—it is important to select an initial screening test with sensitivity to detect all etiologies of hypercortisolism.
What’s the difference between patients who present with Cushingoid features vs those who do not?
THE 1-MG DEXAMETHASONE SUPPRESSION TEST (DST) IS RECOMMENDED FOR A SUSPECTED ADRENAL SOURCE OF HYPERCORTISOLISM5,6
The Endocrine Society Guidelines recommend a more sensitive 1-mg DST cutoff of >1.8 μg/dL to screen for a suspected adrenal source of hypercortisolism.5
1-MG DST
Measures suppression of adrenocorticotropic hormone and autonomous cortisol secretion
≤1.8 μg/dL
May exclude autonomous cortisol secretion
>1.8 μg/dL
Evidence of possible hypercortisolism.
Additional tests are needed to support a diagnosis
How reliable is the 1-mg DST?
The urinary-free cortisol (UFC) test may be less reliable in patients suspected of having an adrenal source of hypercortisolism, since these patients will often have normal UFC results4,7
The Endocrine Society Guidelines recommend a 1-mg DST rather than the UFC test for patients suspected of having an adrenal source of hypercortisolism5
The late-night salivary cortisol test may have a low sensitivity for predicting the presence of adrenal autonomous cortisol secretion8
References
1. Catargi B, Rigalleau V, Poussin A, et al. J Clin Endocrinol Metab. 2003;88(12):5808-5813. doi:10.1210/jc.2003-030254 2. Chiodini I, Torlontano M, Scillitani A, et al. Eur J Endocrinol. 2005;153(6):837-844. doi:10.1530/eje.1.02045 3. Steffensen C, Pereira AM, Dekkers OM, Jørgensen JO. Eur J Endocrinol. 2016;175(6):R247-R253. doi:10.1530/EJE-16-0434 4. Giovanelli L, Aresta C, Favero V, et al. J Endocrinol Invest. 2021;44(8):1581-1596. doi:10.1007/s40618-020-01484-2 5. Nieman LK, Biller BM, Findling JW, et al. J Clin Endocrinol Metab. 2008;93(5):1526-1540. doi:10.1210/jc.2008-0125 6. Fassnacht M, Tsagarakis S, Terzolo M, et al. Eur J Endocrinol. 2023;189(1):G1-G42. doi:10.1093/ejendo/lvad066 7. Chiodini I, Ramos-Rivera A, Marcus AO, Yau H. J Endocr Soc. 2019;3(5):1097-1109. doi:10.1210/js.2018-00382 8. Kuzu I, Zuhur SS, Demir N, Aktas G, Yener Ozturk F, Altuntas Y. Endokrynol Pol. 2016;67(5):487-492. doi:10.5603/EP.a2016.0028