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Cushing syndrome management

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https://www.readbyqxmd.com/read/28895465/paraneoplastic-cushing-syndrome-case-series-and-review-of-the-literature
#1
Annelies Deldycke, Christel Haenebalcke, Youri Taes
OBJECTIVES: Paraneoplastic Cushing syndrome is a rare condition, representing a small fraction of the adrenocorticotropic hormone (ACTH)-dependent cases of Cushing syndrome Methods: Four case descriptions and literature review, highlighting the diagnostic challenges and treatment options are presented. RESULTS: Different tumor types can be associated with ectopic ACTH secretion. The most common types are bronchial carcinoids and small cell lung carcinoma (SCLC)...
September 12, 2017: Acta Clinica Belgica
https://www.readbyqxmd.com/read/28872770/hormone-secreting-adrenal-tumours-cause-severe-hypertension-and-high-rates-of-poor-pregnancy-outcome-a-ukoss-study-with-case-control-comparisons
#2
G Quartermaine, K Lambert, K Rees, P T Seed, M K Dhanjal, M Knight, D R McCance, C Williamson
OBJECTIVE: To examine the management and outcomes of adrenal tumours in pregnancy. DESIGN: A national observational, cohort study over four years using the UK Obstetric Surveillance System (UKOSS). SETTING: Consultant led obstetric units. PATIENTS: Women with phaeochromocytoma, primary aldosteronism or Cushing's syndrome diagnosed before or during pregnancy. METHODS: Clinical features of UKOSS cases were compared to those of women with adrenal tumours reported from 1985-2015...
September 5, 2017: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/28846797/otolaryngic-manifestations-of-cushing-disease
#3
Edward C Kuan, Kevin A Peng, Jeffrey D Suh, Marvin Bergsneider, Marilene B Wang
Cushing disease is a relatively rare cause of Cushing syndrome secondary to a hyperfunctioning pituitary adenoma. In addition to signs and symptoms of hypercortisolism, Cushing disease may present with diverse otolaryngic manifestations, which may guide diagnosis and management. We performed a retrospective chart review of patients who were found to have Cushing disease and who underwent transnasal transsphenoidal surgery for pituitary adenomas between January 1, 2007, and July 1, 2014, at a tertiary academic medical center...
August 2017: Ear, Nose, & Throat Journal
https://www.readbyqxmd.com/read/28816283/-surgery-treatment-of-ectopic-adrenocorticotrophic-hormone-syndrome
#4
H Fan, H Z Li, W F Xu, Z G Ji, Y S Zhang
OBJECTIVE: To investigation the diagnosis and treatment of ectopic adrenocorticotrophic hormone (ACTH) syndrome. METHODS: The clinical characters of 57 cases of ecotopic ACTH syndrome from Jan. 1996 to Dec. 2016 were collected and analyzed. The 57 cases included 32 males and 25 females. The age ranged from 11 to 68 years (average 32 years). ACTH levels significantly increased from 16.5 to 365.6 pmol/L, with average 77.6 pmol/L (normal range <10.1 pmol/L). The pituitary MRI did not found lesions...
August 18, 2017: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
https://www.readbyqxmd.com/read/28801285/-clinical-analysis-of-939-patients-with-adrenal-lesions-detected-by-abdominal-computed-tomography
#5
Cun-Xia Fan, Jia-Jun Zhang, Ying-Ying Cai, Chun-Yan Wu, Shao-Zhou Zou, Yi-Kai Xu, Yao-Ming Xue, Mei-Ping Guan
OBJECTIVE: To investigate the prevalence, etiology and clinical characteristics of adrenal lesions detected by abdominal computed tomography (CT). METHODS: This retrospective study was conducted in patients with adrenal lesions detected by abdominal CT examinations in Nanfang Hospital between July, 2014 and June, 2015. The clinical data of the patients were collected for analysis of the demographics, comorbidities, imaging characteristics, biochemical profiles, clinical diagnosis and intervention...
August 20, 2017: Nan Fang Yi Ke da Xue Xue Bao, Journal of Southern Medical University
https://www.readbyqxmd.com/read/28794862/case-report-an-incidentaloma-that-catches-your-eye-adrenal-myelolipoma
#6
Rosanna D'Addosio, Joselyn Rojas, Valmore Bermúdez, Flor Ledesma, Kyle Hoedebecke
Background: Adrenal incidentaloma refers to the incidental finding of a tumor in the adrenal gland, where nonfunctional forms are the most common variant. Myelolipoma is a rare (0.08-0.4%) occurrence characterized by adipose and hematopoietic tissue. The aim of this case report is to describe the diagnosis and appropriate management of a myelolipoma in an asymptomatic patient, which was originally considered an incidental hepatic hemangioma prior to being identified as a giant adrenal adenoma. Case description: The patient was a 54 year old obese female with a recent diagnosis of diabetes type II and dyslipidemia with recent ultrasound imaging suggestive of a hepatic hemangioma...
2017: F1000Research
https://www.readbyqxmd.com/read/28698830/prevalence-and-predictors-of-home-use-of-glucometers-in-diabetic-patients
#7
Syed A Farhan, Ali T Shaikh, Maria Zia, Bilal R Kahara, Ramsha Muneer, Muzna Rehman, Ayesha Mubashir, Hassaan Sadiq, Durr-E-Amna Siddiqui, Syed M Haseeb, Hafsa Tanveer, Khadijah Siddiq, Saib B Mujtaba, Samir A Mirza, Hira Feroz, Kaneez Fatima
BACKGROUND: Self-monitoring of blood glucose (SMBG) is a critical component of diabetes care. However, it has been shown that use of glucometers in developing countries such as Pakistan is limited. The aim of this study was to determine the frequency of glucometer usage in the urban diabetic population of Karachi and to identify variables that influenced the likelihood of practice of SMBG. METHODS: A cross-sectional study was conducted among 567 adult diabetic patients selected at random from the out-patient departments of multiple healthcare institutions in Karachi categorized into two settings; Government and Private...
June 10, 2017: Curēus
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
#8
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
#9
REVIEW
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/28614007/ectopic-cushing-syndrome-a-10-year-experience-from-a-tertiary-care-center-in-southern-india
#10
Samantha Sathyakumar, Thomas Vizhalil Paul, Hesargatta Shyamsunder Asha, Birla Roy Gnanamuthu, M J Paul, Deepak Thomas Abraham, Simon Rajaratnam, Nihal Thomas
OBJECTIVE: Ectopic adrenocorticotropic hormone (ACTH) secretion is a less common cause of Cushing syndrome and is seen in 5 to 10% of cases with endogenous hypercortisolemia. We hereby describe our experience of patients with ectopic ACTH syndrome, who have been managed over the past 10 years at a tertiary care center in Southern India. METHODS: The inpatient and outpatient records of patients from 2006 to 2015 were retrospectively reviewed. The clinical features, clinical history, biochemical values, imaging features, including radiologic findings and positron emission tomography scans, management, details of follow-up, and outcomes, were documented...
August 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28567290/acth-secreting-medullary-thyroid-cancer-a-case-series
#11
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/28458895/case-of-diabetic-ketoacidosis-as-an-initial-presentation-of-cushing-s-syndrome
#12
Runa Acharya, Udaya M Kabadi
SUMMARY: Diabetic ketoacidosis (DKA) is commonly encountered in clinical practice. The current case is a unique and rare presentation of DKA as the initial manifestation of Cushing's disease secondary to ACTH-secreting pituitary adenoma. Appropriate management as elaborated in the article led to total remission of diabetes as well as the Cushing's disease. LEARNING POINTS: DKA is a serious and potentially life-threatening metabolic complication of diabetes mellitus...
2017: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/28404594/health-related-quality-of-life-of-patients-with-hypothalamic-pituitary-adrenal-axis-dysregulations-a-cohort-study
#13
Charlotte De Bucy, Laurence Guignat, Tanya Niati, Jérôme Bertherat, Joel Coste
OBJECTIVE: Health-related quality of life (HrQoL) is increasingly considered to be an important outcome of care for hypothalamic-pituitary-adrenal (HPA) axis dysregulation. The objective of this study was to assess the influence of type of HPA axis dysregulation and cortisol status on HrQOL and its evolution with time and treatment. DESIGN: Prospective cohort study. METHODS: Between September 2007 and April 2014, HrQoL questionnaires were administered during routine management to all patients with HPA axis dysregulation hospitalized in a single department, and this was repeated after 6- 12-, 24- and 36-month during standard follow-up...
July 2017: European Journal of Endocrinology
https://www.readbyqxmd.com/read/28393326/psychiatric-symptoms-in-patients-with-cushing-s-syndrome-prevalence-diagnosis-and-management
#14
REVIEW
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...
May 2017: Drugs
https://www.readbyqxmd.com/read/28377801/current-best-practice-in-the-management-of-patients-after-pituitary-surgery
#15
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/28368467/glucose-metabolism-abnormalities-in-cushing-syndrome-from-molecular-basis-to-clinical-management
#16
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 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...
June 1, 2017: Endocrine Reviews
https://www.readbyqxmd.com/read/28351913/management-of-endocrine-disease-quality-of-life-tools-for-the-management-of-pituitary-disease
#17
REVIEW
Susan M Webb, Iris Crespo, Alicia Santos, Eugenia Resmini, Anna Aulinas, Elena Valassi
BACKGROUND: In the last few years, quality of life (QoL) has become an outcome measure in patients with pituitary diseases. OBJECTIVE: To describe the available data on QoL impairment evaluated with questionnaires in patients with pituitary diseases. DESIGN: Critical review of the pertinent literature and pragmatic discussion of available information. METHODS: Selection of relevant literature from PubMed and WOK, especially from the last 5 years and comprehensive analysis...
July 2017: European Journal of Endocrinology
https://www.readbyqxmd.com/read/28294570/how-does-obesity-affect-the-endocrine-system-a-narrative-review
#18
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...
June 2017: Clinical Obesity
https://www.readbyqxmd.com/read/28247312/interference-in-acth-immunoassay-negatively-impacts-the-management-of-subclinical-hypercortisolism
#19
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
#20
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...
August 2017: Langenbeck's Archives of Surgery
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