Pros and cons of screening for occult Cushing syndrome
- 22 March 2011
- journal article
- review article
- Published by Springer Science and Business Media LLC in Nature Reviews Endocrinology
- Vol. 7 (8), 445-455
- https://doi.org/10.1038/nrendo.2011.51
Abstract
Systematic screening studies performed mainly in patients with diabetes mellitus have revealed an unexpectedly high prevalence of occult Cushing syndrome. Such studies may provide a rationale for systematically screening obese patients with type 2 diabetes mellitus. However, a screening strategy is only justified if it is supported by enough evidence of its efficacy and if the benefits will outweigh drawbacks. To date, the natural history of occult Cushing syndrome and its possible effect on long-term morbidity are unknown. The clinical spectrum of occult Cushing syndrome and its relatively low prevalence may potentially negatively affect the performance of endocrine tests used to diagnose overt Cushing syndrome and generate false positives. Whether the cure of occult Cushing syndrome favorably influences clinical outcomes and is more beneficial than treatment of diabetes mellitus and cardiovascular risk factors with currently available pharmacological tools remains to be demonstrated. Last, the acceptability of a screening program by professionals and the health-care system in terms of workload and costs is highly questionable. Thus, an assessment of the indications for and against screening for occult Cushing syndrome on the basis of currently available data suggests that, to date, the cons surpass the pros.Keywords
This publication has 115 references indexed in Scilit:
- Primary adrenal hypercortisolism: minimally invasive surgical treatment or medical therapy? A retrospective study with long-term follow-up evaluationSurgical Endoscopy, 2010
- Screening for Cushing’s Syndrome in Obese PatientsClinics, 2010
- Harmonizing the Metabolic SyndromeCirculation, 2009
- Specificity of Screening Tests for Cushing’s Syndrome in an Overweight and Obese PopulationJournal of Clinical Endocrinology & Metabolism, 2009
- Tissue-specific glucocorticoid action: a family affairTrends in Endocrinology & Metabolism, 2008
- The Diagnosis of Cushing's Syndrome: An Endocrine Society Clinical Practice GuidelineJournal of Clinical Endocrinology & Metabolism, 2008
- Measuring inconsistency in meta-analysesBMJ, 2003
- A Clinical Index for Rating Severity in Cushing’s SyndromePsychotherapy and Psychosomatics, 2000
- The Basophil Adenomas of the Pituitary Body and Their Clinical Manifestations (Pituitary Basophilism)1Obesity Research, 1994
- Corticosterone's dual metabolic actionsLife Sciences, 1989