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Diagnosis of Cushing

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https://www.readbyqxmd.com/read/29219752/negative-surgical-exploration-in-patients-with-cushing-s-disease-benefit-of-two-thirds-gland-resection-on-remission-rate-and-a-review-of-the-literature
#1
Steven B Carr, Bette K Kleinschmidt-DeMasters, Janice M Kerr, Katja Kiseljak-Vassiliades, Margaret E Wierman, Kevin O Lillehei
OBJECTIVE The authors report their single-institution experience with the pathological findings, rates of remission, and complications in patients with presumed Cushing's disease (CD) who underwent a two-thirds pituitary gland resection when no adenoma was identified at the time of transsphenoidal surgery (TSS). The authors also review the literature on patients with CD, negative surgical exploration, and histological findings. METHODS This study is a retrospective analysis of cases found in neurosurgery and pathology department databases between 1989 and 2011...
December 8, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29212586/hypercortisolemia-and-depressive-like-behaviors-in-a-rhesus-macaque-macaca-mulatta-involved-in-visual-research
#2
Sean C Adams, Christine M Guyot, Kristina M Berry, Seth T Wallack, Andrew S Loar, Mathias Leblanc
A 10-y-old cranially implanted rhesus macaque (Macaca mulatta) involved in visual research was presented for dull mentation and weight loss. Physical examination revealed alopecia and poor body conditioning, and bloodwork revealed marked hypercortisolemia (23 μg/dL). Differential diagnoses for hypercortisolemia, weight loss, and alopecia included Cushing and pseudo-Cushing syndromes. To further evaluate hypercortisolemia, we compared the urine cortisol:creatinine ratio (UCCR) at baseline and after low-dose dexamethasone suppression (LDDS) testing in the presenting animal and healthy naïve and implanted working monkeys...
December 1, 2017: Comparative Medicine
https://www.readbyqxmd.com/read/29211058/decreased-lymphocytes-and-increased-risk-for-infection-are-common-in-endogenous-pediatric-cushing-syndrome
#3
Christina Tatsi, Rebecca Boden, Ninet Sinaii, Meg Keil, Charalampos Lyssikatos, Elena Belyavskaya, Sergio D Rosenzweig, Constantine A Stratakis, Maya B Lodish
BackgroundHypercortisolemia results in changes of the immune system and elevated infection risk, but data on the WBC changes in pediatric Cushing syndrome (CS) are not known. We describe the changes of the WBC lineages in pediatric endogenous hypercortisolemia, their associations with the markers of disease severity, and the presence of infections.MethodsWe identified 197 children with endogenous CS. Clinical and biochemical data were recorded. Sixty-six children with similar age and gender, and normocortisolemia served as controls...
December 6, 2017: Pediatric Research
https://www.readbyqxmd.com/read/29208661/plasma-steroid-metabolome-for-diagnosis-and-subtyping-patients-with-cushing-syndrome
#4
Graeme Eisenhofer, Jimmy Masjkur, Mirko Peitzsch, Guido Di Dalmazi, Martin Bidlingmaier, Matthias Grüber, Julia Fazel, Andrea Osswald, Felix Beuschlein, Martin Reincke
BACKGROUND: Diagnosis of Cushing syndrome requires a multistep process that includes verification of hypercortisolism followed by identification of the cause of adrenocortical hyperfunction. This study assessed whether pituitary, ectopic, and adrenal subtypes of Cushing syndrome were characterized by distinct plasma steroid profiles that might assist diagnosis. METHODS: In this retrospective cross-sectional study, mass spectrometric measurements of a panel of 15 plasma steroids were applied to 222 patients tested for Cushing syndrome...
December 5, 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/29202350/case-report-ectopic-cushing-s-syndrome-in-a-young-male-with-hidden-lung-carcinoid-tumor
#5
Ghanem Aljassem, Hazem Aljasem
INTRODUCTION: Ectopic Cushing syndrome is a form of Cushing's in which a tumor outside the pituitary gland produces adrenocorticotropic hormone (ACTH). Small cell carcinoma and carcinoid of the lung comprises half of its cases. The main purpose of this study is to present a case of ectopic Cushing syndrome caused by a hidden lung carcinoid and how to manage it. PRESENTATION OF CASE: Here we present a case of a 26year old young male complains of increased weight and appetite, proximal muscle weakness, easy bruising and appearing of purple striae on his abdomen, with a final diagnosis of ACTH secreting lung carcinoid...
November 28, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/29197558/clinical-utility-of-an-ultrasensitive-late-night-salivary-cortisol-assay-by-tandem-mass-spectrometry
#6
Lillian R Sturmer, Dylan Dodd, Christina S Chao, Run-Zhang Shi
BACKGROUND: Late night salivary cortisol measurement is a clinically important and convenient screening test for Cushing's syndrome. Tandem mass spectrometry (LC-MS/MS) assays have superior sensitivity and specificity compared to immunoassays. Our goal was to improve a LC-MS/MS method to measure salivary cortisol in both adult and pediatric patients and to characterize its analytical performance by method validation and clinical performance by chart review. METHODS: We improved a LC-MS/MS method originally developed for urine cortisol to measure low level salivary cortisol...
November 29, 2017: Steroids
https://www.readbyqxmd.com/read/29161416/combined-ovarian-and-adrenal-venous-sampling-in-the-localization-of-acth-independent-ectopic-cushing-s-syndrome
#7
Shi Chen, Ran Li, Xiaobo Zhang, Lin Lu, Ji Li, Hui Pan, Huijuan Zhu
Context: Cushing's syndrome is rarely caused by the secretion of cortisol from the ovarian tumors. It is important to determine whether the ovarian tumor is capable of secreting cortisol or not in clinical decision making. Selective ovarian and adrenal venous sampling has not been reported previously in the localization of ACTH-independent ectopic Cushing's syndrome. Case description: Herein, we presented a case of 40-year-old Chinese woman who has been manifested with weight gain, hirsutism, hypertension and menstrual disorder over a period of 6 months...
November 16, 2017: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/29144801/utility-of-a-single-late-night-plasma-cortisol-and-acth-for-the-diagnosis-of-cushing-s-syndrome
#8
Kush Dev Singh Jarial, Anil Bhansali, Kanchan K Mukherjee, Rimesh Pal, Akhilesh Sharma, Rakesh K Vashishtha, Suja P Sukumar, Naresh Sachdeva, Rama Walia
OBJECTIVE: To evaluate the diagnostic efficacy of various screening tests for the diagnosis of Cushing's syndrome (CS). METHODS: 35 patients of Cushing's syndrome and 16 patients of pseudo-Cushing's syndrome were enrolled. Assessment of 24h urinary free cortisol (UFC), late night salivary cortisol (LNSC), over night dexamethasone suppression test (ONDST), late night plasma cortisol (LNPC) and ACTH on outpatient basis, and during sleep as well as in awake state after 48 hours of hospital admission...
November 16, 2017: Endocrine Practice
https://www.readbyqxmd.com/read/29143179/diagnostic-work-up-in-steroid-myopathy
#9
REVIEW
Marco Alessandro Minetto, Valentina D'Angelo, Emanuela Arvat, Santosh Kesari
INTRODUCTION: Steroid myopathy is a well-known sign of endogenous Cushing's syndrome as well as a side effect of glucocorticoid administration. The clinical finding of muscle weakness and the clinical inspection of the muscle size are the most commonly used diagnostic tools, sometimes in combination with needle electromyography, but there are no means to detect the myopathy before the appearance of clinical or electrodiagnostic signs. Until now, no guidelines have been produced for a disease-specific evaluation of muscle impairment in patients with Cushing's syndrome...
November 15, 2017: Endocrine
https://www.readbyqxmd.com/read/29134170/effectiveness-of-bilateral-inferior-petrosal-sinuses-sampling-in-tumor-lateralization-intraoperative-findings-and-postoperative-results
#10
Pablo Harker, Oscar Feo-Lee, Manuel Giraldo-Grueso, Juan Carlos Puentes
Object  Diagnosis and treatment of Cushing's disease (CD) is a demanding endeavor. We evaluated the effectiveness of inferior petrosal sinus sampling (IPSS) in preoperative tumor lateralization and surgical outcomes. Methods  Fifty-two consecutive patients with CD and normal magnetic resonance imaging (MRI) were enrolled between 2009 and 2015. Selective catheterization of petrosal sinuses for IPSS was performed. All patients underwent microsurgical dissection, and if a lesion was found, underwent lesion resection...
December 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/29122730/cerebral-venous-sinus-thrombosis-following-second-transsphenoidal-surgery-report-of-a-rare-complication-and-review-of-literature
#11
Zhuangzhuang Miao, Zhuo Zhang, Juan Chen, Junwen Wang, Huaqiu Zhang, Ting Lei
BACKGROUND: Cushing's disease, induced by pituitary adrenocorticotropic hormone (ACTH) secreting adenomas, is associated with high risk factors of stroke. At present, transsphenoidal surgery remains the first line of therapy. Cerebral venous sinus thrombosis (CVST) is an uncommon form of stroke with variable presentations but, to date, there have been no reports of its occurrence in Cushing's disease patients following surgery. CASE DESCRIPTION: We herein report a Cushing's disease case who suffered CVST a few days after a second transsphenoidal surgery...
November 6, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29118985/acute-development-of-cushing-syndrome-in-an-hiv-infected-child-on-atazanavir-ritonavir-based-antiretroviral-therapy
#12
Gueorgui Dubrocq, Andrea Estrada, Shannon Kelly, Natella Rakhmanina
An 11-year-old male with perinatally acquired human immune deficiency virus (HIV) infection on antiretroviral regimen, which included abacavir plus lamivudine (Epzicom), didanosine, ritonavir and atazanavir presented with bilateral axillary striae, increased appetite, fatigue, facial swelling and acute weight gain. Two months prior to presentation, the patient had received a diagnostic and therapeutic intra-articular triamcinolone injection in the knee for pain relief and subsequently became progressively swollen in the face, developed striae bilaterally at the axillae, experienced increased appetite, fatigue and an 8 pound weight gain...
2017: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/29094256/efficacy-of-dexamethasone-suppression-test-during-the-diagnosis-of-primary-pigmented-nodular-adrenocortical-disease-in-chinese-adrenocorticotropic-hormone-independent-cushing-syndrome
#13
Shi Chen, Ran Li, Lin Lu, Lian Duan, Xuebin Zhang, Anli Tong, Hui Pan, Huijuan Zhu, Zhaolin Lu
OBJECTIVE: To evaluate the cut-off value of the ratio of 24 h urinary free cortisol (24 h UFC) levels post-dexamethasone to prior-dexamethasone in dexamethasone suppression test (DST) during the diagnosis of primary pigmented nodular adrenocortical disease in Chinese adrenocorticotropic hormone-independent Cushing syndrome. DESIGN: Retrospective study. PARTICIPANTS: The patients diagnosed with primary pigmented nodular adrenocortical disease (PPNAD, n = 25), bilateral macronodular adrenal hyperplasia (BMAH, n = 27), and adrenocortical adenoma (ADA, n = 84) were admitted to the Peking Union Medical College Hospital from 2001 to 2016...
November 1, 2017: Endocrine
https://www.readbyqxmd.com/read/29080355/tumour-lateralization-in-cushing-s-disease-by-inferior-petrosal-sinus-sampling-with-desmopressin
#14
Ming Feng, Ziyuan Liu, Xiaohai Liu, Xiaobo Zhang, Xinjie Bao, Yong Yao, Kan Deng, Bing Xing, Wei Lian, Huijuan Zhu, Lin Lu, Renzhi Wang
BACKGROUND: Bilateral inferior petrosal sinus sampling (IPSS) with corticotropin-releasing hormone (CRH) is currently the gold standard in the diagnosis of Cushing's disease (CD) and has also been used in tumour lateralization. Our objective was to determine the diagnostic value and lateralization accuracy of IPSS with desmopressin. METHODS: We retrospectively analyzed 91 patients with Cushing's syndrome who had either negative findings on pituitary dynamic enhanced magnetic resonance imaging (MRI) or non-suppressed high dose dexamethasone suppression tests (HDDST)...
October 28, 2017: Clinical Endocrinology
https://www.readbyqxmd.com/read/29071077/assessing-the-use-of-breathesmart%C3%A2-mobile-technology-in-adult-patients-with-asthma-a-remote-observational-study
#15
Emilie Melvin, Anna Cushing, Anne Tam, Ruri Kitada, Melissa Manice
INTRODUCTION: Non-adherence to asthma daily controller medications is a common problem, reported to be responsible for 60% of asthma-related hospitalisations. The mean level of adherence for asthma medications is estimated to be as low as 22%. Therefore, objective measurements of adherence to medicine are necessary. This virtual observational study is designed to measure the usability of an electronic monitoring device platform that measures adherence. Understanding how patients use the BreatheSmart mobile technology at home is essential to assess its feasibility as a solution to improve medication adherence...
2017: BMJ Open Respiratory Research
https://www.readbyqxmd.com/read/29034650/a-complicated-case-of-resistant-hypertension
#16
Mauro Chiarito, Andrea Scotti, Carlo A Pivato, Giuseppe Cottone, Carlo Ballarotto, Cosmo Godino, Alberto Margonato
A 47-year-old woman presented with a history of resistant arterial hypertension, associated with disabling headache. She was subjected to an enormous number of tests in order to identify an underlying cause of secondary hypertension, such as pheochromocytoma or Cushing syndrome, but all the most common causes of secondary hypertension were investigated and gradually excluded. Factitious use of amphetamine or cocaine was excluded, and therapy compliance was verified by witnessed ingestion of drug therapy, in order to rule out Munchausen syndrome...
August 2017: Acta Medica Iranica
https://www.readbyqxmd.com/read/29032459/predictors-of-silent-corticotroph-adenoma-recurrence-a-large-retrospective-single-center-study-and-systematic-literature-review
#17
Fabienne Langlois, Dawn Shao Ting Lim, Chris G Yedinak, Isabelle Cetas, Shirley McCartney, Justin Cetas, Aclan Dogan, Maria Fleseriu
PURPOSE: Silent corticotroph adenomas (SCAs) are clinically silent and non-secreting, but exhibit positive adrenocorticotropic hormone (ACTH) immunostaining. We characterized a single center cohort of SCA patients, compared the SCAs to silent gonadotroph adenomas (SGAs), identified predictors of recurrence, and reviewed and compared the cohort to previously published SCAs cases. METHODS: Retrospective review of SCA and SGA surgically resected patients over 10 years and 6 years, respectively...
October 14, 2017: Pituitary
https://www.readbyqxmd.com/read/29032119/a-systematic-review-of-safety-and-efficacy-of-systemic-corticosteroids-in-atopic-dermatitis
#18
Sherry Yu, Aaron M Drucker, Mark Lebwohl, Jonathan I Silverberg
BACKGROUND: Systemic corticosteroids are often used to treat atopic dermatitis (AD). However, few studies assessed the safety and efficacy of systemic corticosteroids in AD. OBJECTIVE: To systematically review the literature on efficacy and safety of systemic corticosteroid use (oral, intramuscular, intravenous) in AD. METHODS: PubMed, Embase, Medline, Scopus, Web of Science, and Cochrane Library were searched. We included systematic reviews, guidelines and treatment reviews of systemic corticosteroid use among patients of all ages with a diagnosis of AD (52 reviews and 12 studies)...
October 12, 2017: Journal of the American Academy of Dermatology
https://www.readbyqxmd.com/read/29027854/long-term-outcomes-of-tissue-based-acth-antibody-assay-guided-transsphenoidal-resection-of-pituitary-adenomas-in-cushing-disease
#19
J Mark Erfe, Avital Perry, John McClaskey, Silvio E Inzucchi, Whitney Sheen James, Tore Eid, Richard A Bronen, Amit Mahajan, Anita Huttner, Florecita Santos, Dennis Spencer
OBJECTIVE Cushing disease is caused by a pituitary micro- or macroadenoma that hypersecretes adrenocorticotropic hormone (ACTH), resulting in hypercortisolemia. For decades, transsphenoidal resection (TSR) has been an efficacious treatment but with certain limitations, namely precise tumor localization and complete excision. The authors evaluated the novel use of a double-antibody sandwich assay for the real-time quantitation of ACTH in resected pituitary specimens with the goals of augmenting pathological diagnosis and ultimately improving long-term patient outcome...
October 13, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28994151/negative-hepatic-computed-tomographic-attenuation-pattern-in-a-dog-with-vacuolar-hepatopathy-and-hepatic-fat-accumulation-secondary-to-cushing-s-syndrome
#20
Andrea Carloni, Michaela Paninarova, Damiano Cavina, Mariarita Romanucci, Leonardo Della Salda, Simone Teodori, Massimo Vignoli
This report describes an unusual computed tomographic (CT) hepatic pattern, characterized by negative attenuation values (from -19.59 to -28.85 Hounsfield Units, HU) in a canine patient with severe Cushing's syndrome. Attenuation values of the splenic parenchyma (63.26 HU) and abdominal fat (-118.34 HU) were within normal limits. The negative hepatic attenuation values allowed a CT diagnosis of severe hepatic fatty infiltration that was subsequently confirmed by tissue-core biopsy and histopathological examination...
October 9, 2017: Veterinary Radiology & Ultrasound
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