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Diagnosis of Cushing

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https://www.readbyqxmd.com/read/28644084/comparison-of-two-methods-for-determining-prevalence-of-macrorhabdus-ornithogaster-in-a-flock-of-captive-budgerigars-melopsittacus-undulatus
#1
Patrick J Sullivan, Edward C Ramsay, Cheryl B Greenacre, Andrew C Cushing, Xiaojuan Zhu, Michael P Jones
Macrorhabdus ornithogaster is a yeast organism that infects multiple species of captive and wild birds. Diagnosis of infection in vivo has proven difficult historically, as shedding can be intermittent, and not all positive animals are clinically ill. We compared polymerase chain reaction (PCR) of cloacal swab samples and fecal Gram's stain (FGS) for diagnosis of active shedding of M ornithogaster in a captive flock of budgerigars ( Melopsittacus undulatus ). Of the 100 birds sampled, 57 (57%) were positive for M ornithogaster by PCR and 24 (24%) were positive for M ornithogaster by FGS...
June 2017: Journal of Avian Medicine and Surgery
https://www.readbyqxmd.com/read/28642733/a-case-of-pulmonary-carcinoid-tumor-with-a-superimposed-aspergilloma-presenting-as-a-covert-ectopic-adrenocorticotropic-hormone-syndrome
#2
Kyoung Jin Kim, Ji Hee Yu, Nan Hee Kim, Young Hye Kim, Young Sik Kim, Ji A Seo
Ectopic adrenocorticotropic hormone (ACTH) syndrome is a challenging diagnosis only responsible for approximately 10% of Cushing syndrome cases. It has been associated with a variety of benign and malignant tumors including a carcinoid tumor accompanied by aspergilloma in our case that was significantly difficult to be detected. We report a patient over 70 years old with uncontrolled hypertension and hypokalemia presenting with generalized edema. Laboratory results revealed ACTH-dependent Cushing syndrome, but imaging studies did not show any discrete lesions secreting ACTH...
2017: Frontiers in Endocrinology
https://www.readbyqxmd.com/read/28637948/in-the-overnight-dexamethasone-suppression-test-1-0-mg-loading-is-superior-to-0-5-mg-loading-for-diagnosing-subclinical-adrenal-cushing-s-syndrome-based-on-plasma-dexamethasone-levels-determined-using-liquid-chromatography-tandem-mass-spectrometry
#3
Yosuke Sasaki, Takuyuki Katabami, Shiko Asai, Hisashi Fukuda, Yasushi Tanaka
The low-dose dexamethasone suppression test (DST) is one of the commonly used initial tests for endogenous Cushing's syndrome (CS). However, there are two loading dose regimens (0.5-mg and 1-mg), which may cause some confusion in daily practice in Japan; furthermore, there are no reports regarding whether 0.5-mg DST is a better loading dose for detecting adrenal subclinical CS (SCS) based on the plasma dexamethasone (DEX) levels. Therefore, the aims of this study were (a) to develop a novel assay to measure DEX by using liquid chromatography tandem-mass spectrometry (LC-MS/MS) and (b) to compare between the 0...
June 21, 2017: Endocrine Journal
https://www.readbyqxmd.com/read/28626863/prolactin-correction-for-adequacy-of-petrosal-sinus-cannulation-may-diminish-diagnostic-accuracy-in-cushing-s-disease
#4
Sunita Mc De Sousa, Ann I McCormack, Shaun McGrath, David J Torpy
OBJECTIVE: Petrosal venous prolactin concentrations have been promoted to improve the diagnostic accuracy of inferior petrosal sinus sampling (IPSS), beyond that achieved with ACTH measurement alone, in diagnosing a pituitary ACTH source, and determining corticotrophinoma side (L/R). Our objective was to assess the effect of using prolactin to confirm adequacy of petrosal cannulation in a cohort of patients with ACTH-dependent Cushing's syndrome. DESIGN: Retrospective cohort study...
June 19, 2017: Clinical Endocrinology
https://www.readbyqxmd.com/read/28623531/elevated-serum-beta-d-glucan-with-pseudomonas-aspergillus-and-a-partially-acid-fast-organism-in-respiratory-cultures-a-case-of-hickam-s-dictum-over-occam-s-razor
#5
Salman Khan, Camille Hamula, Meenakshi Rana, Timothy Sullivan, Dallas Dunn, Pinki Patel, Aaron Mishkin, Shirish Huprikar
We describe a case of a man with ectopic Cushing's syndrome, elevated serum beta-D-glucan, and respiratory cultures with Pseudomonas, Aspergillus, and a partially acid-fast organism. Our case highlights challenges in diagnosis and management of coinfection in an immunocompromised host.
June 16, 2017: Mycopathologia
https://www.readbyqxmd.com/read/28614036/an-individualized-approach-to-the-evaluation-of-cushing-syndrome
#6
Susmeeta T Sharma
Cushing syndrome (CS) is caused by chronic exposure to excess glucocorticoids. Early recognition and treatment of hypercortisolemia can lead to decreased morbidity and mortality. The diagnosis of CS and thereafter, establishing the cause can often be difficult, especially in patients with mild and cyclic hypercortisolism. Surgical excision of the cause of excess glucocorticoids is the optimal treatment for CS. Medical therapy (steroidogenesis inhibitors, medications that decrease adrenocorticotropic hormone [ACTH] levels or glucocorticoid antagonists) and pituitary radiotherapy may be needed as adjunctive treatment modalities in patients with residual, recurrent or metastatic disease, in preparation for surgery, or when surgery is contraindicated...
June 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28614003/biochemical-control-during-long-term-follow-up-of-230-adult-patients-with-cushing-s-disease-a-multi-center-retrospective-study
#7
Eliza B Geer, Ismat Shafiq, Murray B Gordon, Vivien Bonert, Alejandro Ayala, Ronald S Swerdloff, Laurence Katznelson, Yelena Lalazar, Ekaterina Manuylova, Karen J Pulaski-Liebert, John D Carmichael, Zeina Hannoush, Vijaya Surampudi, Michael S Broder, Dasha Cherepanov, Marianne Eagan, Jackie Lee, Qayyim Said, Maureen P Neary, Beverly Mk Biller
OBJECTIVES: Cushing's disease (CD) results from excessive exposure to glucocorticoids caused by an adrenocorticotropic hormone-secreting pituitary tumor. Inadequately-treated CD is associated with significant morbidity and elevated mortality. Multi-center data on CD patients treated in routine clinical practice are needed to assess treatment outcomes in this rare disorder. The study purpose was to describe the burden of illness and treatment outcomes for CD patients. METHODS: Eight pituitary centers in 4 US regions participated in this multi-center retrospective chart review study...
June 14, 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28590513/diagnostic-accuracy-of-increased-urinary-cortisol-cortisone-ratio-to-differentiate-acth-dependent-cushing-s-syndrome
#8
Filippo Ceccato, Laura Trementino, Mattia Barbot, Giorgia Antonelli, Mario Plebani, Luca Denaro, Daniela Regazzo, Federico Rea, Anna Chiara Frigo, Carolina Concettoni, Marco Boscaro, Giorgio Arnaldi, Carla Scaroni
BACKGROUND AND AIM: Differential diagnosis between Cushing's Disease (CD) and Ectopic ACTH Syndrome (EAS) may be a pitfall for endocrinologists. The increasing use in clinical practice of chromatography and mass spectrometry improves the measurement of urinary free cortisol (UFF) and cortisone (UFE). We have recently observed that cortisol to cortisone ratio (FEr) was higher in a small series of EAS; in this paper we collected a larger number of ACTH-dependent CS to study the role of FEr to characterize the source of corticotropin secretion...
June 7, 2017: Clinical Endocrinology
https://www.readbyqxmd.com/read/28589048/the-cushing-reflex-oliguria-as-a-reflection-of-an-elevated-intracranial-pressure
#9
K Leyssens, T Mortelmans, T Menovsky, D Abramowicz, Marcel Th B Twickler, L Van Gaal
Oliguria is one of the clinical hallmarks of renal failure. The broad differential diagnosis is well known, but a rare cause of oliguria is intracranial hypertension (ICH). The actual knowledge to explain this relationship is scarce. Almost all literature is about animals where authors describe the Cushing reflex in response to ICH. We hypothesize that the Cushing reflex is translated towards the sympathetic nervous system and renin-angiotensin-aldosterone system with a subsequent reduction in medullary blood flow and oliguria...
2017: Case Reports in Nephrology
https://www.readbyqxmd.com/read/28567290/acth-secreting-medullary-thyroid-cancer-a-case-series
#10
Ayanthi A Wijewardene, Sarah J Glastras, Diana L Learoyd, Bruce G Robinson, Venessa H M Tsang
Medullary thyroid cancer (MTC) is a rare neuroendocrine tumour that originates from the parafollicular cells of the thyroid gland. The most common presentation of MTC is with a single nodule; however, by the time of diagnosis, most have spread to the surrounding cervical lymph nodes. Cushing's syndrome is a rare complication of MTC and is due to ectopic adrenocorticotrophic hormone (ACTH) secretion by tumour cells. Cushing's syndrome presents a challenging diagnostic and management issue in patients with MTC...
2017: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/28554884/ichthyosis-linearis-circumflexa-with-bamboo-hair-challenges-in-the-diagnosis-and-management
#11
Tanvi Dev, Marwaha Raman Kumar, Gomathy Sethuraman
A 15-year-old boy had persistent and refractory erythroderma since early childhood. His parents noticed polycyclic skin lesions and hair fragility around the age of 5 years. He was treated by a local untrained practitioner for more than 3 years without any significant improvement, and he developed weight gain, thinning of skin, muscle weakness and growth retardation. He was evaluated in 2015 and found to have iatrogenic Cushing's disease with severe skeletal complications and pituitary-adrenal-gonadal suppression, which persisted despite gradual withdrawal of steroids...
May 28, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28532906/first-report-of-coexistence-of-2-ectopic-pituitary-tumors-rathke-cleft-cyst-and-silent-acth-adenoma
#12
Mirza Pojskić, Blazej Zbytek, Neal S Beckford, Frederick A Boop, Kenan I Arnautović
Rathke cleft cysts (RCCs) and pituitary adenomas (PAs) are thought to have a common embryonic ancestry. Despite this, PAs with a concomitant RCC inside the sella turcica are rarely observed; ectopic pituitary tumors are also rare. We present the case of a 65-year-old woman with an ectopic RCC in the sphenoid sinus and outside of the sella turcica concomitant with an adrenocorticotropic hormone (ACTH)-staining, clinically silent PA. The patient presented with headache but no endocrine or visual disturbances...
May 19, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28528327/three-quarters-adrenalectomy-for-infantile-onset-cushing-syndrome-due-to-bilateral-adrenal-hyperplasia-in-mccune-albright-syndrome
#13
Tomoyo Itonaga, Hironori Goto, Manabu Toujigamori, Yasuharu Ohno, Seigo Korematsu, Tatsuro Izumi, Satoshi Narumi, Tomonobu Hasegawa, Kenji Ihara
BACKGROUND: Bilateral adrenalectomy is performed in cases with infantile-onset Cushing syndrome due to bilateral adrenal hyperplasia in McCune-Albright syndrome (MAS) because severe Cushing syndrome with heart failure and liver dysfunction can have a lethal outcome. This procedure can completely ameliorate hypercortisolism, although lifetime steroid replacement therapy and steps to prevent adrenal crisis are necessary. Recently, the efficacy of unilateral adrenalectomy has been reported in adult cases of bilateral macronodular adrenal hyperplasia, but there is no consensus regarding the appropriate surgical treatment for bilateral adrenal hyperplasia in MAS...
May 19, 2017: Hormone Research in Pædiatrics
https://www.readbyqxmd.com/read/28522647/prkar1a-mutation-causing-pituitary-dependent-cushing-disease-in-a-patient-with-carney-complex
#14
Florian W Kiefer, Yvonne Winhofer, Donato Iacovazzo, Marta Korbonits, Stefan Wolfsberger, Engelbert Knosp, Franz Trautinger, Romana Höftberger, Michael Krebs, Anton Luger, Alois Gessl
CONTEXT: Carney complex (CNC) is an autosomal dominant condition caused, in most cases, by an inactivating mutation of the PRKAR1A gene, which encodes for the type 1 alpha regulatory subunit of protein kinase A. CNC is characterized by the occurrence of endocrine overactivity, myxomas and typical skin manifestations. Cushing syndrome due to primary pigmented nodular adrenocortical disease (PPNAD) is the most frequent endocrine disease observed in CNC. CASE DESCRIPTION: Here we describe the first case of a patient with CNC and adrenocorticotropic hormone (ACTH)-dependent Cushing disease due to a pituitary corticotroph adenoma...
May 18, 2017: European Journal of Endocrinology
https://www.readbyqxmd.com/read/28512417/a-case-of-paraneoplastic-cushing-syndrome-presenting-as-hyperglycemic-hyperosmolar-nonketotic-syndrome
#15
Christina E Brzezniak, Nicole Vietor, Patricia E Hogan, Bryan Oronsky, Bennett Thilagar, Carolyn M Ray, Scott Caroen, Michelle Lybeck, Neil Oronsky, Corey A Carter
Carcinoid tumors are neuroendocrine tumors that mainly arise in the gastrointestinal tract, lungs, and bronchi. Bronchopulmonary carcinoids have been associated with Cushing syndrome, which results from ectopic adrenocorticotrophic hormone (ACTH) secretion. We report the case of a 65-year-old man, a colonel in the US Air Force, with metastatic bronchopulmonary carcinoid tumors treated on a clinical trial who was hospitalized for complaints of increasing thirst, polydipsia, polyuria, weakness, and visual changes...
January 2017: Case Reports in Oncology
https://www.readbyqxmd.com/read/28500825/which-type-2-diabetes-mellitus-patients-should-be-screened-for-subclinical-cushing-s-syndrome
#16
Güven Barış Cansu, Sevgi Atılgan, Mustafa Kemal Balcı, Ramazan Sarı, Sebahat Özdem, Hasan Ali Altunbaş
OBJECTIVE: Diabetes or impaired glucose tolerance are common in patients with Cushing's syndrome (CS). In this study we investigated the incidence of subclinical Cushing's syndrome (SCS) in type 2 diabetic patients with poor and good metabolic control and the relationship between blood glucose and cortisol levels. DESIGN: A total of 400 type 2 diabetes mellitus (T2DM) patients (Group A, HbA1c ≥8%, n=250; Group B, HbA1c ≤6.5%, n=150) were included in the study...
January 2017: Hormones: International Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28458898/efficacy-of-pasireotide-in-controlling-severe-hypercortisolism-until-cardiac-transplantation
#17
Roberto Attanasio, Liana Cortesi, Daniela Gianola, Claudia Vettori, Fulvio Sileo, Roberto Trevisan
SUMMARY: Cushing's syndrome is associated with increased morbidity and mortality. Although surgery is the first-line treatment, drugs can still play a role as an ancillary treatment to be employed while waiting for surgery, after unsuccessful operation or in patients unsuitable for surgery. We were asked to evaluate a 32-year-old male waiting for cardiac transplantation. Idiopathic hypokinetic cardiomyopathy had been diagnosed since 6 years. He was on treatment with multiple drugs, had a pacemaker, an implantable cardioverter and an external device for the support of systolic function...
2017: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/28458897/armc5-mutation-in-a-portuguese-family-with-primary-bilateral-macronodular-adrenal-hyperplasia-pbmah
#18
Teresa Rego, Fernando Fonseca, Stéphanie Espiard, Karine Perlemoine, Jérôme Bertherat, Ana Agapito
SUMMARY: PBMAH is a rare etiology of Cushing syndrome (CS). Familial clustering suggested a genetic cause that was recently confirmed, after identification of inactivating germline mutations in armadillo repeat-containing 5 (ARMC5) gene. A 70-year-old female patient was admitted due to left femoral neck fracture in May 2014, in Orthopedics Department. During hospitalization, hypertension (HTA) and hypokalemia were diagnosed. She presented with clinical signs of hypercortisolism and was transferred to the Endocrinology ward for suspected CS...
2017: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/28447709/-atypical-cushing-s-syndrome-in-a-dog-a-case-report
#19
Stefanie Hoffrogge, Lena Fels, Marion Schmicke, Reinhard Mischke
In a 12-year-old male Labrador Retriever, presented due to other disease symptoms, clinical signs of hyperadrenocorticism (polyuria, polydipsia, abdominal distention, muscle atrophy) were an incidental finding. Abnormal laboratory results and sonographic findings of the adrenal glands, but negative low-dose dexamethasone suppression tests with low basal cortisol concentrations, a negative andrenocorticotropic hormone (ACTH)-stimulation test and exclusion of iatrogenic hyperadrenocorticism, suggested an atypical hyperadrenocorticism (AHAC)...
April 27, 2017: Tierärztliche Praxis. Ausgabe K, Kleintiere/Heimtiere
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
#20
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
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