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Endocrinology and Metabolism Clinics of North America

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https://www.readbyqxmd.com/read/29754645/cushing-s-syndrome-2018-best-practices-and-looking-ahead
#1
EDITORIAL
Adriana G Ioachimescu
No abstract text is available yet for this article.
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754644/cushing-s-syndrome-in-pediatrics-an-update
#2
REVIEW
Maya B Lodish, Margaret F Keil, Constantine A Stratakis
Cushing syndrome (CS) is a multisystem disorder resulting from the prolonged exposure to excess glucocorticoids. In children, CS most commonly results from the exogenous administration of steroids and the typical presentation is height deceleration concomitant with weight gain. Endogenous and ectopic causes are rare. CS in children may be associated with distinct germline and somatic mutations. Clinical practice guidelines are available assist clinicians. Patients should be referred to multidisciplinary centers of excellence with experience in endocrinology and surgery...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754643/pregnancy-in-patients-with-cushing-s-syndrome
#3
REVIEW
Marcio Carlos Machado, Maria Candida Barisson Vilares Fragoso, Marcello Delano Bronstein
Progress in diagnosis and treatment of endocrine diseases has made pregnancy possible for women with endocrinopathies, including Cushing's syndrome (CS). The risk of maternal-fetal complications in patients who are not biochemically controlled, however, is substantial. Therefore, the surgical and/or medical control of hypercortisolism is mandatory prior to conceiving. A diagnosis of de novo CS during gestation is difficult due to changes in the hypothalamic-pituitary-adrenal axis during pregnancy, which may lead to some clinical features suggestive of CS along with abnormal laboratory tests...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754642/medical-therapy-for-cushing-s-syndrome-in-the-twenty-first-century
#4
REVIEW
Nicholas A Tritos, Beverly M K Biller
Medical therapy has a useful adjunctive role in many patients with Cushing's syndrome. Patients with pituitary corticotroph adenomas who have received radiation therapy to the sella require medical therapy until the effects of radiation therapy occur. In addition, patients with Cushing's syndrome who cannot undergo surgery promptly, including those who are acutely ill and cannot safely undergo tumor resection, may benefit from medical therapy as a bridge to surgery. Other possible candidates for medical therapy are those with unresectable tumors or those whose tumor location remains unknown despite adequate diagnostic evaluation...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754641/the-ectopic-adrenocorticotropic-hormone-syndrome-rarely-easy-always-challenging
#5
REVIEW
Aimee R Hayes, Ashley B Grossman
Despite modern imaging techniques, differentiating ectopic adrenocorticotropic hormone (ACTH) syndrome from pituitary-dependent Cushing's syndrome, Cushing's disease, is especially difficult when well-differentiated carcinoids are the source of ACTH secretion, particularly pulmonary carcinoid tumors. ACTH-secreting pulmonary carcinoids, like the corticotroph adenomas causing Cushing's disease, are often small and difficult to detect, and patients present with a gradual onset of the classical signs and symptoms of Cushing's syndrome, indistinguishable from the presentation of Cushing's disease...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754640/adrenocortical-carcinoma-with-hypercortisolism
#6
REVIEW
Soraya Puglisi, Paola Perotti, Anna Pia, Giuseppe Reimondo, Massimo Terzolo
Adrenocortical carcinoma (ACC) is a rare and aggressive tumor. ACC may be associated with different syndromes of hormone excess, most frequently Cushing's syndrome with or without hypersecretion of androgens. Recent data suggest that cortisol excess is a negative prognostic factor in advanced and localized ACC. Surgery with radical intent, when feasible, is the most effective treatment for ACC with hypercortisolism. Mitotane is the medical treatment of choice, both postoperatively and in inoperable or metastatic cases...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754639/adrenal-surgery-for-cushing-s-syndrome-an-update
#7
REVIEW
Guido Di Dalmazi, Martin Reincke
Recent advances in the molecular pathogenesis and the natural history of Cushing's syndrome have improved the understanding of the management of this disease. The long-term efficacy of several cortisol-lowering medical treatments is currently under evaluation. However, adrenalectomy is a safe option for the treatment of patients affected by Cushing's syndrome. Unilateral adrenalectomy is the gold standard for treatment of adrenocortical adenomas associated with hypercortisolism. Bilateral adrenalectomy has been widely used in the past as definitive treatment of bilateral macronodular hyperplasia and persistent or recurrent Cushing's disease...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754638/recent-advances-on-subclinical-hypercortisolism
#8
REVIEW
Guido Zavatta, Guido Di Dalmazi
During the last 20 years, a significant body of literature has accumulated regarding subclinical hypercortisolism in patients with adrenal incidentalomas. Retrospective studies have indicated these patients have an increase in cardiovascular events and mortality. Current recommendations for patients with adrenal incidentalomas include an overnight low-dose dexamethasone suppression test and a thorough evaluation of cardiovascular and metabolic risk factors. Further hormonal testing and close monitoring are necessary in patients with incomplete suppression...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754637/new-molecular-targets-for-treatment-of-cushing-s-disease
#9
REVIEW
Elizabeth Foulkes, John Newell-Price
Despite the best outcomes from trans-sphenoidal surgery, approximately one-third of patients with Cushing's disease will need medical therapy. Current treatments have drawbacks and there is a clear clinical need for new therapies. Recent understanding of molecular pathways leading to excess ACTH secretion has identified key components that may be targeted with the aim to provide novel effective treatment for this devastating disease. These include testicular orphan nuclear receptor 4, heat shock protein 90, and epidermal growth factor receptor...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754636/outcomes-of-pituitary-radiation-for-cushing-s-disease
#10
REVIEW
Natasha Ironside, Ching-Jen Chen, Cheng-Chia Lee, Daniel M Trifiletti, Mary Lee Vance, Jason P Sheehan
Achievement of biochemical remission with preservation of normal pituitary function is the goal of treatment for Cushing's disease. For patients with persistent or recurrent Cushing's disease after transsphenoidal resection, radiation therapy may be a safe and effective treatment. Stereotactic radiosurgery is favored over conventional fractionated external beam radiation. Hormonal recurrence rates range from 0% to 36% at 8 years after treatment. Tumor control rates are high. New pituitary hormone deficiency is the most common adverse effect after stereotactic radiosurgery and external beam radiation...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754635/prognostic-factors-of-long-term-remission-after-surgical-treatment-of-cushing-s-disease
#11
REVIEW
Adriana G Ioachimescu
Transsphenoidal surgery is the main treatment of patients with adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas. Although biochemical remission occurs in most patients undergoing operations at specialized centers, the recurrence risk is significant. Visualization of microadenomas on preoperative imaging and confirmation of ACTH-positive adenomas have been associated with higher remission rates. Low cortisol levels in the first 2 weeks postoperatively have been associated with durable remission; however, recurrence cannot be excluded by any cortisol threshold...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754634/mortality-in-patients-with-endogenous-cushing-s-syndrome
#12
REVIEW
Pedram Javanmard, Daisy Duan, Eliza B Geer
Cushing's syndrome is associated with increased morbidity and mortality. Cardiovascular events, sepsis, and thromboembolism are the leading causes of mortality. Patient's with Cushing's due to a pituitary adenoma and those with Cushing's due to benign adrenal adenoma have relatively good survival outcomes often mirroring that of the general population. Persistent or recurrent disease is associated with high mortality risk. Ectopic Cushing's syndrome and Cushing's due to adrenocortical carcinoma confer the highest mortality risk among Cushing's etiologies...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754633/morbidity-of-cushing-s-syndrome-and-impact-of-treatment
#13
REVIEW
Susan M Webb, Elena Valassi
Cortisol excess in Cushing's syndrome is associated with metabolic, cardiovascular, and cognitive alterations, only partially reversible after resolution of hypercortisolism. Elevated cardiovascular risk may persist after eucortisolism has been achieved. Fractures and low bone mineral density are also described in Cushing's syndrome in remission. Hypercortisolism may induce irreversible structural and functional changes in the brain, leading to neuropsychiatric disorders in the active phase of the disease, which persist...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754632/genetics-of-cushing-s-syndrome
#14
REVIEW
Laura C Hernández-Ramírez, Constantine A Stratakis
The knowledge on the molecular and genetic causes of Cushing's syndrome (CS) has greatly increased in the recent years. Somatic mutations leading to overactive 3',5'-cyclic adenosine monophosphate/protein kinase A and wingless-type MMTV integration site family/beta-catenin pathways are the main molecular mechanisms underlying adrenocortical tumorigenesis. Corticotropinomas are characterized by resistance to glucocorticoid negative feedback, impaired cell cycle control and overexpression of pathways sustaining ACTH secretion...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754631/diagnosis-of-cushing-s-syndrome-in-the-modern-era
#15
REVIEW
Lynnette Kaye Nieman
Four challenges complicate the evaluation for Cushing syndrome. These challenges include increasing global prevalence of obesity and diabetes; increasing use of exogenous glucocorticoids, which cause a Cushing syndrome phenotype; the confusion caused by nonpathologic hypercortisolism not associated with Cushing syndrome, which may present with symptoms consistent with Cushing syndrome; and difficulty identifying pathologic hypercortisolism when it is extremely mild or cyclic or in renal failure, incidental adrenal masses, and pregnancy...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29407066/diabetes-and-atherosclerotic-cardiovascular-disease-novel-insights-and-therapeutic-strategies
#16
EDITORIAL
Guillermo E Umpierrez
No abstract text is available yet for this article.
March 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29407065/diabetes-and-atherosclerotic-cardiovascular-disease
#17
EDITORIAL
Adriana G Ioachimescu
No abstract text is available yet for this article.
March 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29407060/cardiovascular-outcomes-of-treatments-available-for-patients-with-type-1-and-2-diabetes
#18
Guillermo E Umpierrez
No abstract text is available yet for this article.
March 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29407059/cardiovascular-outcomes-trials-of-glucose-lowering-drugs-or-strategies-in-type-2-diabetes
#19
REVIEW
Hertzel C Gerstein, Reema Shah
As recently as 20 years ago there were no randomized controlled trials of potentially cardiovascular protective therapies in people with type 2 diabetes. The ongoing cardiovascular trials bring needed evidence. Both primary and subsidiary analyses have transformed diabetes from a largely eminence based specialty to one that is firmly evidence based. These studies have provided evidence supporting glucose-lowering drugs for patients with cardiovascular risk factors. Randomized controlled trials such as those described here will continue to challenge assumptions and create new approaches and paradigms that can be pursued to reduce and hopefully eliminate serious cardiovascular and other consequences of diabetes...
March 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29407058/intensive-blood-glucose-control-and-vascular-outcomes-in-patients-with-type-2-diabetes-mellitus
#20
REVIEW
Marian Sue Kirkman, Hussain Mahmud, Mary T Korytkowski
People with type 2 diabetes mellitus are at high risk of morbidity and mortality from cardiovascular disease (CVD). Based on observed relationships between hyperglycemia and CVD, several large clinical trials have investigated the ability of treatment strategies to achieve hemoglobin A1c less than 7% (53 mmol/mol) as a way of reducing this risk. These studies demonstrate that intensified glycemic therapy may reduce CVD risk in younger patients with recent-onset type 2 diabetes mellitus but not in high-risk older individuals with established disease...
March 2018: Endocrinology and Metabolism Clinics of North America
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