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Cushing syndrome management

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https://www.readbyqxmd.com/read/28294570/how-does-obesity-affect-the-endocrine-system-a-narrative-review
#1
REVIEW
M Poddar, Y Chetty, V T Chetty
Obesity is a chronic, relapsing medical condition that results from an imbalance of energy expenditure and consumption. It is a leading cause of preventable illness, disability and premature death. The causes of obesity are multifactorial and include behavioural, socioeconomic, genetic, environmental and psychosocial factors. Rarely are endocrine diseases, e.g., hypothyroidism or Cushing's syndrome, the cause of obesity. What is less understood is how obesity affects the endocrine system. In this review, we will discuss the impact of obesity on multiple endocrine systems, including the hypothalamic-pituitary axis, changes in vitamin D homeostasis, gender steroids and thyroid hormones...
March 15, 2017: Clinical Obesity
https://www.readbyqxmd.com/read/28247312/interference-in-acth-immunoassay-negatively-impacts-the-management-of-subclinical-hypercortisolism
#2
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/28246963/posterior-retroperitoneoscopic-adrenal-surgery-for-clinical-and-subclinical-cushing-s-syndrome-in-patients-with-bilateral-adrenal-disease
#3
Aoife J Lowery, Barbara Seeliger, Pier F Alesina, Martin K Walz
BACKGROUND: The treatment of hypercortisolism for patients with bilateral adrenal disease (BAD) is controversial. Bilateral total adrenalectomy results in permanent hypocortisolaemia requiring lifelong steroid replacement. A more conservative surgical approach, with less than bilateral total adrenalectomy (leaving functional adrenal tissue either unilaterally or bilaterally), represents an alternative option; however, long-term outcome or recurrence data are limited. We report our experience with the surgical management of hypercortisolism caused by BAD...
February 28, 2017: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/28068682/cushing-s-syndrome-managed-by-endoscopic-ultrasound-guided-radiofrequency-ablation-of-adrenal-gland-adenoma
#4
Sun-Ho Lee, Dong Wan Seo, Dongwook Oh, Tae Jun Song, Do Hyun Park, Sang Soo Lee, Myung-Hwan Kim
No abstract text is available yet for this article.
February 2017: Endoscopy
https://www.readbyqxmd.com/read/28029519/adrenocorticotropic-hormone-levels-before-treatment-predict-recurrence-of-cushing-s-disease
#5
Chun-Heng Kuo, Shyang-Rong Shih, Hung-Yuan Li, Szu-Chi Chen, Po-Ju Hung, Fen-Yu Tseng, Tien-Chun Chang
BACKGROUND/PURPOSE: Cushing's disease (CD) is the most common cause of endogenous Cushing's syndrome. Transsphenoidal surgery (TSS) is the first choice of treatment. Predicting prognosis after treatment can benefit further strategies of management, but currently there is no convenient predictor. This study aims to investigate characteristic changes after treatment and to identify potential prognostic predictors. METHODS: We retrospectively studied the records of CD patients presenting to the National Taiwan University Hospital, Taipei, Taiwan between 1992 and 2011...
October 28, 2016: Journal of the Formosan Medical Association, Taiwan Yi Zhi
https://www.readbyqxmd.com/read/28029028/the-recovery-of-hypothalamic-pituitary-adrenal-axis-is-rapid-in-subclinical-cushing-syndrome
#6
Hee Kyung Kim, Jee Hee Yoon, Yun Ah Jeong, Ho Cheol Kang
BACKGROUND: In subclinical Cushing syndrome (SC), it is assumed that glucocorticoid production is insufficient to cause a clinically recognizable syndrome. Differences in hormonal levels or recovery time of the hypothalamic-pituitary-adrenocortical (HPA) axis after adrenalectomy between patients with overt Cushing syndrome (OC) and SC remain unknown. METHODS: Thirty-six patients (10 with OC and 26 with SC) with adrenal Cushing syndrome who underwent adrenalectomy from 2004 to 2014 were reviewed retrospectively...
December 2016: Endocrinology and Metabolism
https://www.readbyqxmd.com/read/27988912/clinical-characteristics-of-adrenal-tumors-in-children-a-retrospective-review-of-a-15-year-single-center-experience
#7
Xiaokun Lin, Dazhou Wu, Congde Chen, Na Zheng
OBJECTIVE: Adrenal tumors are rare in children. The aim of this study is to review and analyze clinical data on the diagnosis and management of adrenal tumors in children. METHODS: Between 2001 and 2015, 48 pediatric patients (<14 years old) admitted to our institute with adrenal tumors were reviewed. Clinical features, imaging studies, surgical approaches, as well as pathological diagnoses were recorded. RESULTS: The series comprised 28 males and 20 females...
December 17, 2016: International Urology and Nephrology
https://www.readbyqxmd.com/read/27986133/prevention-and-management-of-glucocorticoid-induced-side-effects-a-comprehensive-review-gastrointestinal-and-endocrinologic-side-effects
#8
REVIEW
Avrom Caplan, Nicole Fett, Misha Rosenbach, Victoria P Werth, Robert G Micheletti
Part 2 of this 4-part continuing medical education series continues with a discussion of the prevention and management of gastrointestinal side effects associated with corticosteroid use, including peptic ulcer disease, gastrointestinal bleeding, and pancreatitis, followed by a review of corticosteroid-related endocrinologic side effects, such as diabetes, adrenal suppression, and Cushing syndrome.
January 2017: Journal of the American Academy of Dermatology
https://www.readbyqxmd.com/read/27936531/endocrinology-update-hirsutism
#9
Joel J Heidelbaugh
Hirsutism is defined as excessive terminal hair growth, such as coarse sexual or secondary hair, that typically appears in a male growth pattern in androgen-dependent areas of the female body. It can occur in men and women. Common etiologies include polycystic ovary syndrome, idiopathic hyperandrogenemia, idiopathic hirsutism, adrenal hyperplasia due to 21-hydroxylase deficiency, androgen-secreting tumors, iatrogenic hirsutism, acromegaly, Cushing syndrome, hyperprolactinemia, and hypo- or hyperthyroidism. Diagnostic guidelines are predominantly aimed at premenopausal women but an appropriate evaluation for underlying endocrinopathies in postmenopausal women and men may be required...
December 2016: FP Essentials
https://www.readbyqxmd.com/read/27922495/toxic-and-endocrine-myopathies
#10
Hans D Katzberg, Charles D Kassardjian
PURPOSE OF REVIEW: This article discusses the clinical features, pathophysiology, and management of toxic and endocrine myopathies. RECENT FINDINGS: Early detection and expeditious correction of metabolic disturbances in endocrinopathies such as Cushing syndrome, thyroid and parathyroid diseases, and acromegaly can minimize and prevent neurologic complications including myopathy. Recently proposed mechanisms of injury in patients with critical illness myopathy include inhibition of protein synthesis, mitochondrial dysfunction, disruption of the ubiquitin-proteasome system, oxidative stress, and disruption of intramuscular calcium homeostasis, which can cause a myosin-loss myopathy...
December 2016: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/27869719/targeted-molecular-imaging-in-adrenal-disease-an-emerging-role-for-metomidate-pet-ct
#11
REVIEW
Iosif A Mendichovszky, Andrew S Powlson, Roido Manavaki, Franklin I Aigbirhio, Heok Cheow, John R Buscombe, Mark Gurnell, Fiona J Gilbert
Adrenal lesions present a significant diagnostic burden for both radiologists and endocrinologists, especially with the increasing number of adrenal 'incidentalomas' detected on modern computed tomography (CT) or magnetic resonance imaging (MRI). A key objective is the reliable distinction of benign disease from either primary adrenal malignancy (e.g., adrenocortical carcinoma or malignant forms of pheochromocytoma/paraganglioma (PPGL)) or metastases (e.g., bronchial, renal). Benign lesions may still be associated with adverse sequelae through autonomous hormone hypersecretion (e...
November 18, 2016: Diagnostics
https://www.readbyqxmd.com/read/27864805/endocrine-hypertension-a-practical-approach
#12
REVIEW
Joseph M Pappachan, Harit N Buch
Elevated blood pressure resulting from few endocrine disorders (endocrine hypertension) accounts for a high proportion of cases of secondary hypertension. Although some features may be suggestive, many cases of endocrine hypertension remain silent until worked up for the disease. A majority of cases result from primary aldosteronism. Other conditions that can cause endocrine hypertension are: congenital adrenal hyperplasia, Liddle syndrome, pheochromocytomas, Cushing's syndrome, acromegaly, thyroid diseases, primary hyperparathyroidism and iatrogenic hormone manipulation...
November 19, 2016: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/27729065/symptomatic-cushing-s-syndrome-and-hyperandrogenemia-in-a-steroid-cell-ovarian-neoplasm-a-case-report
#13
Ramy Sedhom, Sophia Hu, Anupam Ohri, Dorian Infantino, Sara Lubitz
BACKGROUND: Malignant steroid cell tumors of the ovary are rare and frequently associated with hormonal abnormalities. There are no guidelines on how to treat rapidly progressive Cushing's syndrome, a medical emergency. CASE PRESENTATION: A 67-year-old white woman presented to our hospital with rapidly developing signs and symptoms of Cushing's syndrome secondary to a steroid-secreting tumor. Her physical and biochemical manifestations of Cushing's syndrome progressed, and she was not amenable to undergoing conventional chemotherapy secondary to the debilitating effects of high cortisol...
October 12, 2016: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/27697800/iatrogenic-cushing-s-syndrome-due-to-drug-interaction-between-glucocorticoids-and-the-ritonavir-or-cobicistat-containing-hiv-therapies
#14
Emilie R Elliot, Aikaterini Theodoraki, Lakshmi R Jain, Neal J Marshall, Marta Boffito, Stephanie E Baldeweg, Laura J Waters
Ritonavir and cobicistat, used as pharmacokinetic enhancers in combination with some antiretrovirals (ARVs) for the treatment of HIV, are potent inhibitors of the CYP3A4 isoenzyme. Most glucocorticoids are metabolised via the CYP3A4 pathway and iatrogenic Cushing's syndrome (ICS), with possible secondary adrenal insufficiency (SAI), is a recognised complication following co-administration with ritonavir or cobicistat. A structured approach for identifying and managing potentially affected individuals has not been established...
October 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27678103/long-term-outcomes-of-children-treated-for-cushing-s-disease-a-single-center-experience
#15
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)...
December 2016: Pituitary
https://www.readbyqxmd.com/read/27512421/adrenal-cortical-carcinoma-mimicking-early-severe-preeclampsia
#16
Elizabeth Jarvis, Adam Morton
Preeclampsia is a common disorder in pregnancy and may affect multiple maternal and foetal organ systems. Less common disorders with similar features may imitate preeclampsia though require different management strategies and with different prognostic implications for mother and baby. We present a case of a pregnant woman who developed severe hypertension and proteinuria in pregnancy. The early onset of these changes prompted investigation for causes other than preeclampsia, leading to a diagnosis of Cushing's syndrome due to stage III adrenocortical cancer...
March 2014: Obstetric Medicine
https://www.readbyqxmd.com/read/27450696/therapy-of-endocrine-disease-improvement-of-cardiovascular-risk-factors-after-adrenalectomy-in-patients-with-adrenal-tumors-and-subclinical-cushing-s-syndrome-a-systematic-review-and-meta-analysis
#17
REVIEW
Irina Bancos, Fares Alahdab, Rachel K Crowley, Vasileios Chortis, Danae A Delivanis, Dana Erickson, Neena Natt, Massimo Terzolo, Wiebke Arlt, William F Young, M Hassan Murad
OBJECTIVE: Beneficial effects of adrenalectomy on cardiovascular risk factors in patients with subclinical Cushing's syndrome (SCS) are uncertain. We sought to conduct a systematic review and meta-analysis with the following objectives: (i) determine the effect of adrenalectomy compared with conservative management on cardiovascular risk factors in patients with SCS and (ii) compare the effect of adrenalectomy on cardiovascular risk factors in patients with SCS vs those with a nonfunctioning (NF) adrenal tumor...
December 2016: European Journal of Endocrinology
https://www.readbyqxmd.com/read/27390021/management-of-adrenal-incidentalomas-european-society-of-endocrinology-clinical-practice-guideline-in-collaboration-with-the-european-network-for-the-study-of-adrenal-tumors
#18
Martin Fassnacht, Wiebke Arlt, Irina Bancos, Henning Dralle, John Newell-Price, Anju Sahdev, Antoine Tabarin, Massimo Terzolo, Stylianos Tsagarakis, Olaf M Dekkers
: By definition, an adrenal incidentaloma is an asymptomatic adrenal mass detected on imaging not performed for suspected adrenal disease. In most cases, adrenal incidentalomas are nonfunctioning adrenocortical adenomas, but may also represent conditions requiring therapeutic intervention (e.g. adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma or metastasis). The purpose of this guideline is to provide clinicians with best possible evidence-based recommendations for clinical management of patients with adrenal incidentalomas based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system...
August 2016: European Journal of Endocrinology
https://www.readbyqxmd.com/read/27335521/cushing-s-syndrome-masquerading-as-treatment-resistant-depression
#19
B N Anil Kumar, Sandeep Grover
Treatment resistant depression (TRD) is a common clinical occurrence among patients treated for major depressive disorder. A significant proportion of patients remain significantly depressed in spite of aggressive pharmacological and psychotherapeutic approaches. Management of patient with treatment resistant depression requires thorough evaluation for physical causes. We report a case of recurrent depressive disorder, who presented with severe depressive episode without psychotic symptoms, not responding to multiple adequate trials of antidepressants, who on investigation was found to have Cushing's syndrome and responded well to Ketoconazole...
May 2016: Indian Journal of Psychological Medicine
https://www.readbyqxmd.com/read/27316348/tongue-squamous-cell-carcinoma-producing-both-parathyroid-hormone-related-protein-and-granulocyte-colony-stimulating-factor-a-case-report-and-literature-review
#20
REVIEW
Naoki Kaneko, Shintaro Kawano, Ryota Matsubara, Yuichi Goto, Teppei Jinno, Yasuyuki Maruse, Taiki Sakamoto, Yuma Hashiguchi, Masakazu Iida, Seiji Nakamura
BACKGROUND: Paraneoplastic syndrome generally results from tumor-derived hormones or peptides that cause metabolic derangements. Common metabolic conditions include hyponatremia, hypercalcemia, hypoglycemia, and Cushing's syndrome. Herein, we report a very rare case of tongue carcinoma presenting with leukocytosis and hypercalcemia. CASE PRESENTATION: A 57-year-old man was admitted to our hospital with tongue squamous cell carcinoma (cT4aN0M0, stage IV). He underwent radical resection following preoperative chemoradiotherapy, but locoregional recurrence was detected 2 months after surgery...
June 17, 2016: World Journal of Surgical Oncology
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