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Diagnosis of Cushing

Jérôme Bertherat
No abstract text is available yet for this article.
October 17, 2016: Endocrine Practice
Dania Hirsch, Gloria Tsvetov, Yossi Manisterski, Nirit Aviran-Barak, Varda Nadler, Sandra Alboim, Vered Kopel
OBJECTIVE: To investigate the incidence of Cushing's syndrome (CS) in patients with significant hypercortisoluria and the performance of urinary free cortisol (UFC) screening. DESIGN: Retrospective file review. METHODS: The computerized database of a publicly funded health maintenance organization (HMO) in Israel was searched for all patients who underwent 24-hour UFC testing in 2005-2014 with a result of more than twice the upper limit of normal (ULN)...
October 13, 2016: European Journal of Endocrinology
Thierry Brue, Frederic Castinetti
Secreting pituitary adenomas that cause acromegaly and Cushing's disease, as well as prolactinomas and thyrotroph adenomas, are uncommon, usually benign, slow-growing tumours. The rarity of these conditions means that their diagnosis is not familiar to most non-specialist physicians. Consequently, pituitary adenomas may be overlooked and remain untreated, and affected individuals may develop serious comorbidities that reduce their quality of life and life expectancy. Because many signs and symptoms of pituitary adenomas overlap with those of other, more common disorders, general practitioners and non-endocrinology specialists need to be aware of the "red flags" suggestive of these conditions...
October 6, 2016: Orphanet Journal of Rare Diseases
Francisca Caimari, Elena Valassi, Patricia Garbayo, Charlotte Steffensen, Alicia Santos, Rosa Corcoy, Susan M Webb
Pregnancy in Cushing's syndrome (CS) is extremely rare due to the influence of hypercortisolism on the reproductive axis. Purpose of this study is to investigate whether the etiology of CS in pregnancy determines a different impact on the fetal/newborn and maternal outcomes. We performed a systematic review of cases published in the literature from January 1952 to April 2015 including the words "Cushing AND pregnancy". We included 168 manuscripts containing 220 patients and 263 pregnancies with active CS during pregnancy and with a history of CS but treated and cured hypercortisolism at the time of gestation...
October 4, 2016: Endocrine
Galina Yordanova, Lee Martin, Farhad Afshar, Ian Sabin, Ghassan Alusi, Nicholas P Plowman, Fiona Riddoch, Jane Evanson, Matthew Matson, Ashley B Grossman, Scott A Akker, John P Monson, William M Drake, Martin O Savage, Helen L Storr
PURPOSE: Pediatric Cushing's disease (CD) is rare and there are limited data on the long-term outcomes. We assessed CD recurrence, body composition, pituitary function and psychiatric comorbidity in a cohort of pediatric CD patients. METHODS: Retrospective review of 21 CD patients, mean age at diagnosis 12.1 years (5.7-17.8), managed in our center between 1986 and 2010. Mean follow-up from definitive treatment was 10.6 years (2.9-27.2). RESULTS: Fifteen patients were in remission following transsphenoidal surgery (TSS) and 5 were in remission following TSS + external pituitary radiotherapy (RT)...
September 27, 2016: Pituitary
Vincent Chen Ye, Ryojo Akagami
BACKGROUND: Our study evaluated the perioperative quality of life (QoL) in Cushing's disease (CD) patients, along with correlations between patient variables and cure rate. METHODS: The 36-item Short-Form Health Survey (SF)-36 questionnaire was used to assess perioperative QoL. Patients completed one survey preoperatively and two surveys postoperatively. Retrospective chart review was conducted to collect SF-36 data as well as examine variables including: age, hospital stay, size of tumour, pathological diagnosis, timing of cure, and complication rates...
September 20, 2016: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
Maria Fleseriu, Amir H Hamrahian, Andrew R Hoffman, Daniel F Kelly, Laurence Katznelson
Recurrence of hypercortisolemia after initial treatment of Cushing's disease (CD) is more common than previously thought, with a third of patients suffering a recurrence over their lifetime. Awareness of this high rate and delayed timeline (sometimes decades) of potential recurrence is critical and patients with CD should be monitored at regular intervals throughout their lives. In this manuscript, we review the complex evaluation needed for defining CD remission versus persistent disease after surgery, and focus on challenges in diagnosing early recurrent hypercortisolemia...
September 19, 2016: Endocrine Practice
A Tirosh, M B Lodish, G Z Papadakis, C Lyssikatos, E Belyavskaya, C A Stratakis
Cortisol diurnal variation may be abnormal among patients with endogenous Cushing syndrome (CS). The study objective was to compare the plasma cortisol AM/PM ratios between different etiologies of CS. This is a retrospective cohort study, conducted at a clinical research center. Adult patients with CS that underwent adrenalectomy or trans-sphenoidal surgery (n=105) were divided to those with a pathologically confirmed diagnosis of Cushing disease (n=21) and those with primary adrenal CS, including unilateral adrenal adenoma (n=28), adrenocortical hyperplasia (n=45), and primary pigmented nodular adrenocortical disease (PPNAD, n=11)...
September 2016: Hormone and Metabolic Research, Hormon- und Stoffwechselforschung, Hormones et Métabolisme
Shuai Liu, Yinyan Wang, Kaibin Xu, Fan Ping, Renzhi Wang, Fang Li, Xin Cheng
Chronic exposure to elevated levels of glucocorticoids can exert a neurotoxic effect in patients, possibly manifesting as molecular imaging alterations in patients. The aim of this study was to investigate the potential association between brain metabolism and elevated hormone level using (18)F-fluorodeoxyglucose positron emission tomography. We retrospectively enrolled 92 consecutive patients with confirmed diagnosis of Cushing's disease. A voxel-based analysis was performed to investigate the association between cerebral (18)F-fluorodeoxyglucose uptake and serum cortisol level...
2016: NeuroImage: Clinical
Takuyuki Katabami, Satoshi Ishii, Ryusei Obi, Shiko Asai, Yasushi Tanaka
Unilateral and/or predominant uptake on adrenocortical scintigraphy (ACS) may be related to autonomous cortisol overproduction in patients with subclinical Cushing's syndrome (SCS). However, there is no information regarding whether increased tracer uptake on the tumor side or decreased uptake on the contralateral side on ACS is more greatly associated with inappropriate cortisol production. Therefore, we evaluated the relationship between quantitative (131)I-6β-iodomethyl-norcholesterol ((131)I-NP-59) uptake in both adrenal glands and parameters of autonomic cortisol secretion and attempted to set a cut off for SCS detection...
September 10, 2016: Endocrine Journal
Fatih Kuzu, Mustafa Unal, Sanser Gul, Taner Bayraktaroglu
Pituitary apoplexy is a medical condition that needs urgent diagnosis and treatment. It may occur spontaneously or may be precipitated by a variety of reasons including dynamic endocrine tests. Although pituitary apoplexy is usually seen in non-functional pituitary adenoma, it can also be seen in ACTH secreting macroadenomas. ACTH secreting adenomas present usually as microadenomas and in these patients apoplexy is rarely seen. In this paper we present a 30 years old male patient with a history of Cushing's disease who suffered from pituitary apoplexy after1 mg dexamethasone suppression test...
February 5, 2016: Turkish Neurosurgery
Bernard Chamontin, Florent Seguro, Nicolas Touront, Béatrice Bouhanick
The purpose is to consider the practical management of etiological work up in hypertension, beyond national or international recommendations, leading to consider the prior practice of hormonal assays or renal, renovascular or adrenal imaging. The ease of access to imaging, difficulties to meet the requirements to obtain reliable hormonal assays explain the use of first-line imaging in clinical practice. The renal and adrenal CT angiography provides diagnostic orientation without allowing a formal conclusion...
August 31, 2016: La Presse Médicale
Ryohei Mineo, Sachiko Tamba, Yuya Yamada, Tomonori Okita, Yusuke Kawachi, Reiko Mori, Mitsuaki Kyo, Kenji Saisho, Yohei Kuroda, Koji Yamamoto, Akiko Furuya, Tokuo Mukai, Takashi Maekawa, Yasuhiro Nakamura, Hironobu Sasano, Yuji Matsuzawa
A 40-year-old man presented with Cushing's syndrome due to bilateral adrenal hyperplasia with multiple nodules. Computed tomography scan results were atypical demonstrating an enlargement of the bilateral adrenal glands harboring multiple small nodules, but the lesion was clinically diagnosed to be primary pigmented nodular adrenocortical disease (PPNAD) based on both endocrinological test results and his family history. We performed bilateral adrenalectomy and confirmed the diagnosis histologically. An analysis of the patient and his mother's genomic DNA identified a novel mutation in the type Iα regulatory subunit of protein kinase A (PRKAR1A) gene; p...
2016: Internal Medicine
Esteban M Repetto, Diego Gonzalez, Dario Jacobsen, Fernando Smithuis, Juan Jamardo, Mariel Cano, Claudio Aranda, Adriana Oneto, Gabriela Berg, Bibiana Fabre
No abstract text is available yet for this article.
August 31, 2016: Clinical Chemistry and Laboratory Medicine: CCLM
L L Li, J T Dou, G Q Yang, W J Gu, Z H Lü, Y M Mu
OBJECTIVE: To summarize the characteristics of the etiology distribution of Cushing syndrome (CS) patients in Chinese PLA general hospital during the past 20 years. METHODS: All data of CS patients admitted to Chinese PLA General Hospital between 1995 and 2014 were collected. The sex ratio of patients, visiting age, final diagnosis were retrospectively analyzed. RESULTS: From January 1995 to December 2014, 522 patients with CS were admitted, of which, 134 (25...
August 16, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
S Poonuru, J W Findling, J L Shaker
This report describes the presence of lower extremity insufficiency fractures in 10 women prior to the clinical and biochemical diagnosis of endogenous Cushing's syndrome (CS). Osteoporosis is a well-recognized complication of overt CS resulting in a high rate of vertebral and other fractures. After institutional review board (IRB) approval, we did a retrospective chart review of patients with lower extremity (LE) insufficiency fractures (IF) and CS. This chart review found 10 women in whom LE-IF preceded the diagnosis of endogenous CS...
August 15, 2016: Osteoporosis International
Antonio León-Justel, Ainara Madrazo-Atutxa, Ana I Alvarez-Rios, Rocio Infantes-Fontán, Juan A Garcia-Arnés, Juan A Lillo-Muñoz, Anna Aulinas, Eulàlia Urgell-Rull, Mauro Boronat, Ana Sánchez-de-Abajo, Carmen Fajardo-Montañana, Mario Ortuño-Alonso, Isabel Salinas-Vert, Maria L Granada, David A Cano, Alfonso Leal-Cerro
CONTEXT: Cushing's syndrome (CS) is challenging to diagnose. Increased prevalence of CS in specific patient populations has been reported, but routine screening for CS remains questionable. To decrease the diagnostic delay and improve disease outcomes, simple new screening methods for CS in at-risk populations are needed. OBJECTIVE: To develop and validate a simple scoring system to predict CS based on clinical signs and an easy-to-use biochemical test. DESIGN: Observational, prospective, multicenter...
October 2016: Journal of Clinical Endocrinology and Metabolism
L Lu, J H Chen, H J Zhu, A L Song, M Li, S Chen, H Pan, F Y Gong, R Z Wang, B Xing, Y Yao, M Feng, Z L Lu
OBJECTIVE: To compare the sensitivity and specificity between the 24 hour urine free cortisol (24 h UFC) and serum cortisol in dexamethasone suppression test (DST) in the diagnosis of Cushing syndrome (CS). METHODS: Combined low dose DST (LDDST) and high dose DST (HDDST) were carried out in 67 cases of CS with surgically confirmed cases in recent 3 years(from January 2011 to November 2015). The serum cortisol and 24 h UFC were collected simultaneously for each subject and the sensitivity and specificity of serum cortisol and 24 h UFC were compared...
July 19, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Hasan Erdem, Süleyman Çetinkünar, Faruk Kuyucu, Hakan Erçil, Mustafa Görür, Selim Sözen
OBJECTIVE: The rate of adrenal incidentalomas detected in routine diagnostic imaging techniques is approximately 4-7%. Although the lesions are generally benign, carcinoma and functional adenomas can be diagnosed with careful clinic and laboratory evaluation. MATERIAL AND METHODS: Data of 13 patients who underwent surgery for an adrenal mass between January 2010-June 2014 were analyzed retrospectively. RESULTS: Seven (54%) patients were male, 6 (46%) were female, and the mean age was 38...
2016: Ulusal Cerrahi Dergisi
Giovanni Vitale, Fabio Tortora, Roberto Baldelli, Francesco Cocchiara, Rosa Maria Paragliola, Emilia Sbardella, Chiara Simeoli, Ferdinando Caranci, Rosario Pivonello, Annamaria Colao
Adrenocorticotropin-secreting pituitary tumor represents about 10 % of pituitary adenomas and at the time of diagnosis most of them are microadenomas. Transsphenoidal surgery is the first-line treatment of Cushing's disease and accurate localization of the tumor within the gland is essential for selectively removing the lesion and preserving normal pituitary function. Magnetic resonance imaging is the best imaging modality for the detection of pituitary tumors, but adrenocorticotropin-secreting pituitary microadenomas are not correctly identified in 30-50 % of cases, because of their size, location, and enhancing characteristics...
July 19, 2016: Endocrine
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