Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Neuroendocrinology 2010;92(suppl 1):96–101 DOI: 10.1159/000314272 Metabolic Syndrome in Cushing’s Syndrome Philippe Chanson   a–c Sylvie Salenave   a a  Assistance Publique-Hôpitaux de Paris, Service d’Endocrinologie et des Maladies de la Reproduction, Hôpital de Bicêtre, et b  Institut National de la Santé et de la Recherche Médicale, Unité 693, et c  Faculté de Médecine Paris-Sud, Université Paris-Sud 11, Le Kremlin-Bicêtre, France and diabetes, respectively), hypertension (more than 70% of the patients), and elevated triglyceride levels (20% of the pa- tients). Almost two thirds of CS patients fulfill at least three criteria for MetS. The elevated incidence of diabetes and pre- mature atherosclerosis (directly related to the length of ex- posure to hypercortisolism), and the increased mortality (particularly cardiovascular mortality) relative to the general population (2 to 4 times higher) show that the predictive val- ue of MetS is also valid in CS. Effective treatment of hyper- cortisolism improves each of the five MetS components, but MetS and carotid atherosclerosis persist in most patients, and the cardiovascular risk therefore remains elevated. This calls for aggressive treatment of comorbidities and for very long-term follow-up. Copyright © 2010 S. Karger AG, Basel What Is Metabolic Syndrome? Metabolic syndrome (MetS) is defined as a complex of interrelated risk factors, including obesity (particularly central obesity), elevated fasting glucose (FG), hyperten- sion, elevated serum triglycerides (TG), and low high- density-lipoprotein cholesterol (HDL-C). The tendency of these factors to cluster was discovered many years ago. Insulin resistance is considered to be the factor linking these different metabolic abnormalities, but the patho- genesis of MetS is unclear. MetS is common in industrial- Key Words Metabolic syndrome  Diabetes mellitus  Cardiovascular risk  Growth hormone deficiency  Cushing’s syndrome  Glucocorticoids Abstract Although the concept of metabolic syndrome (MetS) as a disease entity continues to be debated, it provides a means by which patients at risk for diabetes and cardiovascular dis- ease can be identified and categorized with routinely avail- able criteria. Insulin resistance plays a central role in these abnormalities. Risk factors include central obesity, elevated fasting glucose, hypertension, elevated serum triglycerides, and low high-density-lipoprotein cholesterol. Various defi- nitions of MetS have been proposed since 1998. Recently, a joint statement by several major organizations concluded that three abnormal values in a series of five criteria deter- mined whether a person had MetS, and that elevated waist circumference was not an obligatory feature. A single set of cutoff points was proposed, except for waist circumference, which should be defined according to population and ethnic group. Cushing’s syndrome (CS) represents an archetype of MetS. High glucocorticoid levels lead to muscle, liver and ad- ipocyte insulin resistance. Almost all patients with CS are obese or overweight, and have abdominal visceral adiposity. Many also have glucose metabolism abnormalities (21–60% and 20–47% of the patients have impaired glucose tolerance Published online: September 10, 2010 Philippe Chanson Service d’Endocrinologie et des Maladies de la Reproduction Hôpital de Bicêtre FR–94275 Le Kremlin-Bicêtre (France) Tel. +33 1 45 21 37 08, Fax +33 1 45 21 22 12, E-Mail philippe.chanson  @  bct.aphp.fr © 2010 S. Karger AG, Basel 0028–3835/10/0925–0096$26.00/0 Accessible online at: www.karger.com/nen