CLINICS 2010;65(1):9-13 Table 2 - Laboratory findings in the study patients Simple obesity ACTH (pg/ml) 25.7 [15-51] Cortisol (µg/dL) 10.2 [7.8-14.8] Glucose (mg/dL) 99 [91-113] Insulin (mU/ml) 14.7 [7.4-24.2] f T4 (ng/dL) 1.2 [1.07-1.4] TSH (mIU/L) 1.64 [0.9-2.8] Cholesterol (mg/dL) 203 [172-249] LDL-c (mg/dL) 129 [97-159] HDL-c (mg/dL) 44 [37.5-50.5] VLDL-c (mg/dL) 24 [17-33] Triglyceride (mg/dL) 120 [86-161] Urine cortisol (µg/24 h) 28 [15-92.5] DMST cortisol (µg/dL) 0.88 [0.7-1.15] HOMA-R 4.02 (mg/dl x mU/ml) [1.91-6.59] Values are medians and interquartile ranges. DMST: 1-mg dexamethasone suppression test Cushing’s syndrome 35 [13.5-94.5] 9.4 [8.1-13.5] 100 [93.5-114] 18.9 [14.9-28.5] 1.1 [1.04-1.63] 1.78 [1.6-4.2] 238.5 [178.-264] 168 [122-168] 46 [29-66] 38 [16.2-50] 208 [89.8-251] 74 [27-133] 3.35 [2.5-6.5] 4.66 [4.38-9.08] Table 3 - Etiologies of the 14 patients diagnosed with Cush- ing’s syndrome Pituitary adenoma Surrenal cortex adenoma Surrenal cortex carcinoma Declined further evaluation N 9 3 1 1 p 0.43 0.88 0.91 0.07 0.56 0.25 0.24 0.15 0.72 0.2 0.15 0.02 < 0.0001 0.06 % 64.28 21.42 7.15 7.15 Screening Cushing’s Syndrome in Obesity Tiryakioglu O et al. Figure 1 - Twenty-four-hour free cortisol levels in patients with Cushing’s syndrome and simple obesity Figure 2 - The comparison of the 1-mg dexamethasone suppression test results for both groups in mean values for serum lipids, glucose, BMI, systolic blood pressure, or waist-to-hip ratio. Diastolic pressure was higher in patients with CS (p=0.02). Although higher HOMA-R values were recorded in patients with CS (median, 4.66 mg/dL x mU/ml; IQR, 1.38-9.08) compared to simple obese patients (median, 4.02 mg/dL x mU/ml; IQR, 1.91- 6.59), the difference between the two groups narrowly failed to achieve statistical significance (p=0.06). DISCUSSION We compared the group of 14 obese patients with CS to the remaining group of 136 patients with simple obesity. There was no significant difference in levels of ACTH (p=0.43) or basal cortisol (p=0.88) between the CS group and the group of simple obese patients without CS. However, 24-h UFC excretion (Figure 1) and morning cortisol levels following administration of 1 mg DMS (Figure 2) were significantly more elevated in obese patients with CS than in simple obese patients without CS. There were no significant differences between the groups Here, we report on 150 obese patients screened for CS. A diagnosis of CS was established in 14 patients (9.33%). This finding confirms the need to evaluate patients with simple obesity for CS despite the absence of other signs or symptoms of the disorder. This conclusion is supported by several previous studies. Obesity is a frequent clinical sign of CS, and adipose tissues in CS patients typically have a central distribution. Obese patients with CS may live without any evident metabolic disorder associated with CS. However, 11