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Diagnosis of Cushing

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https://www.readbyqxmd.com/read/28420444/case-report-acth-secreting-pituitary-carcinoma-metastatic-to-the-liver-in-a-patient-with-a-history-of-atypical-pituitary-adenoma-and-cushing-s-disease
#1
Amy S Joehlin-Price, Douglas A Hardesty, Christina A Arnold, Lawrence S Kirschner, Daniel M Prevedello, Norman L Lehman
BACKGROUND: Pituitary carcinoma is a rare entity requiring the presence of metastasis to confirm its malignant potential. We report a case of pituitary carcinoma and discuss the diagnosis and management of this lesion in relation to the existing literature. CASE PRESENTATION: The patient is a 51-year-old woman with Cushing's disease and intact adrenal glands who was diagnosed with metastatic pituitary carcinoma to the liver, 29 months after initial resection of an ACTH-secreting primary atypical pituitary adenoma (APA)...
April 18, 2017: Diagnostic Pathology
https://www.readbyqxmd.com/read/28413388/a-case-report-of-cushing-s-disease-presenting-as-hair-loss
#2
Emily G Lefkowitz, Jack P Cossman, John B Fournier
Cushing's syndrome is a rare endocrine disorder that comprises a large group of signs and symptoms resulting from chronic exposure to excess corticosteroids. Most cases of Cushing's syndrome are due to increased adrenocorticotropic hormone production from a pituitary adenoma, which is referred to as Cushing's disease. Most of the signs and symptoms are nonspecific and common in the general population, making a diagnosis often challenging. However, several dermatological manifestations, such as fragile skin, easy bruising, and reddish purple striae, are more discriminatory...
January 2017: Case Reports in Dermatology
https://www.readbyqxmd.com/read/28402781/diagnosis-and-differential-diagnosis-of-cushing-s-syndrome
#3
D Lynn Loriaux
No abstract text is available yet for this article.
April 13, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28393326/psychiatric-symptoms-in-patients-with-cushing-s-syndrome-prevalence-diagnosis-and-management
#4
Alicia Santos, Eugenia Resmini, Juan Carlos Pascual, Iris Crespo, Susan M Webb
Cushing's syndrome (CS) results from chronic exposure to cortisol excess, produced by the adrenal cortex. Hypercortisolism predisposes to psychiatric and neurocognitive disorders, mainly to depression and anxiety disorders. Screening tools to identify psychiatric symptoms are available for clinicians in their daily practice, although a specific diagnosis should be performed by specialists. Even if psychiatric symptoms improve after remission of hypercortisolism, complete recovery may not be achieved. Given the burden of these symptoms, psychiatric or psychological monitoring and treatment should be offered through all phases of CS, with a multidisciplinary approach...
April 10, 2017: Drugs
https://www.readbyqxmd.com/read/28382019/transcriptome-analysis-showed-a-differential-signature-between-invasive-and-non-invasive-corticotrophinomas
#5
Leonardo Jose Tadeu de Araújo, Antonio Marcondes Lerario, Margaret de Castro, Clarissa Silva Martins, Marcello Delano Bronstein, Marcio Carlos Machado, Ericka Barbosa Trarbach, Maria Candida Barisson Villares Fragoso
ACTH-dependent hypercortisolism caused by a pituitary adenoma [Cushing's disease (CD)] is the most common cause of endogenous Cushing's syndrome. CD is often associated with several morbidities, including hypertension, diabetes, osteoporosis/bone fractures, secondary infections, and increased cardiovascular mortality. While the majority (≈80%) of the corticotrophinomas visible on pituitary magnetic resonance imaging are microadenomas (MICs, <10 mm of diameter), some tumors are macroadenomas (MACs, ≥10 mm) with increased growth potential and invasiveness, exceptionally exhibiting malignant demeanor...
2017: Frontiers in Endocrinology
https://www.readbyqxmd.com/read/28380523/genomewide-association-study-reveals-a-risk-locus-for-equine-metabolic-syndrome-in-the-arabian-horse
#6
S L Lewis, H M Holl, C Streeter, C Posbergh, B J Schanbacher, N J Place, M F Mallicote, M T Long, S A Brooks
Equine obesity can cause life-threatening secondary chronic conditions, similar to those in humans and other animal species. Equine metabolic syndrome (EMS), primarily characterized by hyperinsulinemia, is often present in obese horses and ponies. Due to clinical similarities to conditions such as pituitary pars intermedia dysfunction (formerly equine Cushing's disease), conclusive diagnosis of EMS often proves challenging. Aside from changes in diet and exercise, few targeted treatments are available for EMS, emphasizing the need for early identification of at-risk individuals to enable implementation of preventative measures...
March 2017: Journal of Animal Science
https://www.readbyqxmd.com/read/28377801/current-best-practice-in-the-management-of-patients-after-pituitary-surgery
#7
REVIEW
Alessandro Prete, Salvatore Maria Corsello, Roberto Salvatori
Sellar and parasellar masses are a common finding, and most of them are treated surgically via transsphenoidal approach. This type of surgery has revolutionized the approach to several hypothalamic-pituitary diseases and is usually effective, and well-tolerated by the patient. However, given the complex anatomy and high density of glandular, neurological and vascular structures in a confined space, transsphenoidal surgery harbors a substantial risk of complications. Hypopituitarism is one of the most frequent sequelae, with central adrenal insufficiency being the deficit that requires a timely diagnosis and treatment...
March 2017: Therapeutic Advances in Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28377460/diagnostic-tests-for-cushing-s-syndrome-differ-from-published-guidelines-data-from-ercusyn
#8
MULTICENTER STUDY
Elena Valassi, Holger Franz, Thierry Brue, Richard A Feelders, Romana Netea-Maier, Stylianos Tsagarakis, Susan M Webb, Maria Yaneva, Martin Reincke, Michael Droste, Irina Komerdus, Dominique Maiter, Darko Kastelan, Philippe Chanson, Marija Pfeifer, Christian J Strasburger, Miklós Tóth, Olivier Chabre, Antoine Tabarin, Michal Krsek, Carmen Fajardo, Marek Bolanowski, Alicia Santos, John A H Wass, Peter J Trainer
OBJECTIVE: To evaluate which tests are performed to diagnose hypercortisolism in patients included in the European Registry on Cushing's syndrome (ERCUSYN), and to examine if their use differs from the current guidelines. PATIENTS AND METHODS: We analyzed data on the diagnostic tests performed in 1341 patients with Cushing's syndrome (CS) who have been entered into the ERCUSYN database between January 1, 2000 and January 31, 2016 from 57 centers in 26 European countries...
May 2017: European Journal of Endocrinology
https://www.readbyqxmd.com/read/28371654/extended-low-dose-dexamethasone-suppression-test-for-diagnosis-of-atypical-cushing-s-syndrome-in-dogs
#9
K M Fowler, L A Frank, F Morandi, J C Whittemore
The purpose of this study was to evaluate extension of the low-dose dexamethasone suppression (LDDS) test from 8 h to 12 h to detect possible hypercortisolemia associated with atypical hyperadrenocorticism (AHAC). Twelve client-owned dogs were enrolled in the study: 6 healthy dogs (group 1) and 6 dogs with suspected AHAC (group 2). Baseline EDTA plasma samples were collected for endogenous ACTH determination using an immunoradiometric assay. Serum samples were collected before and at 4, 8, 10, and 12 h post-administration of 0...
March 11, 2017: Domestic Animal Endocrinology
https://www.readbyqxmd.com/read/28368467/glucose-metabolism-abnormalities-in-cushing-s-syndrome-from-molecular-basis-to-clinical-management
#10
Carla Scaroni, Marialuisa Zilio, Michelangelo Foti, Marco Boscaro
An impaired glucose metabolism, which often leads to the onset of diabetes mellitus (DM), is a common complication of chronic exposure to exogenous and endogenous glucocorticoid (GC) excess, and plays an important part in contributing to morbidity and mortality in patients with Cushing's syndrome (CS).This article reviews the pathogenesis, epidemiology, diagnosis and management of changes in glucose metabolism associated with hypercortisolism, addressing both the pathophysiological aspects and the clinical and therapeutic implications...
March 20, 2017: Endocrine Reviews
https://www.readbyqxmd.com/read/28364356/diabetes-in-cushing-disease
#11
REVIEW
G Mazziotti, A M Formenti, S Frara, F Maffezzoni, M Doga, A Giustina
PURPOSE OF REVIEW: This review focuses on the pathophysiological and clinical aspects of diabetes mellitus occurring in patients with Cushing disease (CD). RECENT FINDINGS: Insulin resistance and impairment in insulin secretion are both involved in the pathogenesis of glucocorticoid-induced diabetes. Correction of glucocorticoid excess does not always resolve abnormalities of glucose homeostasis, and correction of hyperglycaemia is specifically required. In fact, insulin resistance may persist even after correction of glucocorticoid excess and diabetes needs to be treated for long term...
May 2017: Current Diabetes Reports
https://www.readbyqxmd.com/read/28356253/adrenocortical-carcinoma-masquerading-as-cushing-s-disease
#12
Kush Dev Jarial, Rama Walia, Santosh Kumar, Anil Bhansali
Cushing's syndrome (CS) can be classified as adrenocorticotropic hormone (ACTH)-dependent or ACTH-independent depending on the ACTH levels. However, 30% of the patients with CS have ACTH levels in the 'grey zone' (5-20 pg/mL), thereby posing a challenge in establishing the aetiological diagnosis. In a patient with full-blown features of Cushing's syndrome with equivocal ACTH levels, and a pituitary microadenoma on contrast-enhanced MRI sella, can falsely lead to a diagnosis of Cushing's disease. Pituitary microadenoma, if <6 mm in size, may be an incidental finding (incidentaloma) in this scenario and can be present in ∼3-27% of the healthy population...
March 29, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28329633/comorbidities-of-hospitalized-pemphigus-patients-in-the-united-states
#13
Derek Y Hsu Y Hsu
We sought to determine the comorbid health conditions and inpatient mortality associated with pemphigus in a U.S. inpatient cohort. The 2002-2012 Nationwide Inpatient Sample, which contains a representative 20% stratified sample of all inpatient hospitalizations in the US, was analyzed. Comorbidities were determined through ICD-9-CM codes. Survey weighted multivariate logistic regression models controlling for demographic factors were constructed to determine the association of pemphigus with various comorbidities...
September 15, 2016: Dermatology Online Journal
https://www.readbyqxmd.com/read/28289402/medical-therapy-with-pasireotide-in-recurrent-cushing-s-disease-experience-of-patients-treated-for-at-least-1%C3%A2-year-at-a-single-center
#14
Chris G Yedinak, Sarah Hopkins, Jessica Williams, Aly Ibrahim, Justin Schultz Cetas, Maria Fleseriu
Subcutaneous (SC) injection of pasireotide, a somatostatin analog, is approved for the treatment of adults with Cushing's disease (CD) for whom pituitary surgery was unsuccessful or is not an option. We highlight the symptomatic and biochemical improvement of six patients with recurrent CD treated with pasireotide SC at a single center for at least 1 year. Patients were treated either through commercial use (n = 5) or through the Phase 3 trial (n = 1; http://ClinicalTrials.gov identifier, NCT00434148; study number, B2305)...
2017: Frontiers in Endocrinology
https://www.readbyqxmd.com/read/28289104/scalp-hair-cortisol-for-diagnosis-of-cushing-s-syndrome
#15
Vincent L Wester, Martin Reincke, Jan W Koper, Erica L T van den Akker, Laura Manenschijn, Christina M Berr, Julia Fazel, Yolanda B de Rijke, Richard A Feelders, Elisabeth F C van Rossum
OBJECTIVE: Current first-line screening tests for Cushing's syndrome (CS) only measure time-point or short-term cortisol. Hair cortisol content (HCC) offers a non-invasive way to measure long-term cortisol exposure over several months of time. We aimed to evaluate HCC as a screening tool for CS. DESIGN: Case-control study in two academic referral centers for CS. METHODS: Between 2009 and 2016, we collected scalp hair from patients suspected of CS and healthy controls...
June 2017: European Journal of Endocrinology
https://www.readbyqxmd.com/read/28277127/a-successful-case-of-pregnancy-in-a-woman-with-acth-independent-cushing-s-syndrome-treated-with-ketoconazole-and-metyrapone
#16
Wojciech Zieleniewski, Renata Michalak
Cushing's syndrome (CS) is a rare disease caused by a chronic excess of cortisol. Hypercortisolaemia may affect reproductive system leading to infertility in women. However, some of the patients remain fertile, although pregnancy is uncommon. In our report, we describe the case of a 31-years old woman suffering from hypertension, oligomenorrhea, easy bruising, muscle weakness and elevated levels of cortisol. During hospitalization, high level of serum cortisol with stiff diurnal rhythm and undetectable plasma ACTH concentration were found...
February 26, 2017: Gynecological Endocrinology
https://www.readbyqxmd.com/read/28247312/interference-in-acth-immunoassay-negatively-impacts-the-management-of-subclinical-hypercortisolism
#17
Serkan Yener, Leyla Demir, Mustafa Demirpence, Mustafa Mahmut Baris, Ilgin Yildirim Simsir, Secil Ozisik, Abdurrahman Comlekci, Tevfik Demir
PURPOSE: Low plasma corticotropin is considered a useful parameter for the diagnosis of subclinical hypercortisolism in patients with an adrenal incidentaloma. However, immunoassays are vulnerable to interference from endogenous antibodies. In this study, subjects who underwent Hypothalamus-pituitary-adrenal axis evaluation for the assessment of subclinical hypercortisolism were evaluated. The objective of the study was to ascertain whether antibody interference in corticotropin immunoassay affected the diagnostic work-up and clinical decisions...
February 28, 2017: Endocrine
https://www.readbyqxmd.com/read/28222414/urinary-steroid-metabolites-in-a-case-of-florid-ectopic-cushing-s-syndrome-and-clinical-correlations
#18
Angelos Kyriacou, Karolina M Stepien, Basil Issa
A 51-year old woman was admitted with multiple cerebral, pulmonary and intra-abdominal abscesses. The combination of apparent immunosuppression, obesity, diabetes mellitus, hypertension, hypokalaemia, osteoporotic fractures and bilateral shoulder avascular necrosis led to a clinical diagnosis of Cushing's syndrome (CS). This was biochemically confirmed as follows: midnight serum cortisol 4275 nmol/L (60-250), non-suppressed overnight dexamethasone suppression test, raised salivary cortisol 716 nmol/L (5-46) and ACTH 639 ng/L (0-46)...
October 2016: Hormones: International Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28210785/on-glioblastoma-and-the-search-for-a-cure-where-do-we-stand
#19
REVIEW
John Bianco, Chiara Bastiancich, Aleksander Jankovski, Anne des Rieux, Véronique Préat, Fabienne Danhier
Although brain tumours have been documented and recorded since the nineteenth century, 2016 marked 90 years since Percival Bailey and Harvey Cushing coined the term "glioblastoma multiforme". Since that time, although extensive developments in diagnosis and treatment have been made, relatively little improvement on prognosis has been achieved. The resilience of GBM thus makes treating this tumour one of the biggest challenges currently faced by neuro-oncology. Aggressive and robust development, coupled with difficulties of complete resection, drug delivery and therapeutic resistance to treatment are some of the main issues that this nemesis presents today...
February 17, 2017: Cellular and Molecular Life Sciences: CMLS
https://www.readbyqxmd.com/read/28183788/prognostic-factors-in-ectopic-cushing-s-syndrome-due-to-neuroendocrine-tumors-a-multicenter-study
#20
MULTICENTER STUDY
Maria Vittoria Davi', Elisa Cosaro, Serena Piacentini, Giuseppe Reimondo, Nora Albiger, Giorgio Arnaldi, Antongiulio Faggiano, Giovanna Mantovani, Nicola Fazio, Alessandro Piovesan, Emanuela Arvat, Franco Grimaldi, Letizia Canu, Massimo Mannelli, Alberto Giacinto Ambrogio, Francesca Pecori Giraldi, Chiara Martini, Andrea Lania, Manuela Albertelli, Diego Ferone, Maria Chiara Zatelli, Davide Campana, Annamaria Colao, Carla Scaroni, Massimo Terzolo, Laura De Marinis, Sara Cingarlini, Rocco Micciolo, Giuseppe Francia
OBJECTIVE: Evidence is limited regarding outcome of patients with ectopic Cushing's syndrome (ECS) due to neuroendocrine tumors (NETs). DESIGN: We assessed the prognostic factors affecting the survival of patients with NETs and ECS. METHODS: Retrospective analysis of clinicopathological features, severity of hormonal syndrome, treatments from a large cohort of patients with NETs and ECS collected from 17 Italian centers. RESULTS: Our series included 110 patients, 58...
April 2017: European Journal of Endocrinology
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