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Hypercortisolism

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https://www.readbyqxmd.com/read/28069628/cushing-s-syndrome-a-practical-approach-to-diagnosis-and-differential-diagnoses
#1
Joseph M Pappachan, Christian Hariman, Mahamood Edavalath, Julian Waldron, Fahmy W Hanna
Diagnosis of Cushing's syndrome (CS) and identification of the aetiology of hypercortisolism can be challenging. The Endocrine Society clinical practice guidelines recommends one of the four tests for initial screening of CS, namely, urinary-free cortisol, late night salivary cortisol, overnight dexamethasone suppression test or a longer low-dose dexamethasone suppression test, for 48 hours. Confirmation and localisation of CS requires additional biochemical and radiological tests. Radiological evaluation involves different imaging modalities including MRI with or without different radio-nuclear imaging techniques...
January 9, 2017: Journal of Clinical Pathology
https://www.readbyqxmd.com/read/28068878/long-term-control-of-hypercortisolism-by-vandetanib-in-a-medullary-thyroid-carcinoma-with-a-somatic-ret-mutation
#2
Anne-Cécile Paepegaey, Beatrix Cochand-Priollet, Estelle Louiset, Pierre Olivier Sarfati, Marco Alifano, Nelly Burnichon, Marie Bienvenu-Perrard, Najiba Lahlou, Léopoldine Bricaire, Lionel Groussin
CONTEXT: Medullary thyroid carcinomas (MTCs) complicated by ectopic Cushing's syndrome have a poor prognosis, partially due to the difficulties to control hypercortisolism by adrenal blocking drugs. Recent reports (including the initial follow-up of this patient) have suggested that tyrosine kinase inhibitors (TKIs) may be a therapeutic option due to an antisecretory action on ACTH. However, there is a lack of long-term follow-up studies. CASE DESCRIPTION: We report the case of a 58 year-old man with a MTC-related Cushing's syndrome resistant to a combination of several anticortisolic drugs...
January 9, 2017: Thyroid: Official Journal of the American Thyroid Association
https://www.readbyqxmd.com/read/28065244/advances-in-evaluation-of-cognitive-impairment-in-patients-with-cushing-s-disease
#3
Wei-Yu Mao, Hui You, Bing Xing, Hui-Juan Zhu, Feng Feng
Cushing's disease (CD) is a relatively rare disease,characterized by pathological hypercortisolism secondary to excessive adrenocorticotrophic hormone that is secreted by pituitary adrenocorticotrophic hormone adenoma or hyperplasia. In addition to the typical clinical symptoms such as moon face,buffalo hump,and central obesity,the CD patients may also experience mental disorders and cognitive dysfunction. This review mainly focuses on the cognitive state of CD patients,the mechanisms of cognitive impairment caused by high cortisol levels,and the imaging findings (especially magnetic resonance imaging) for the evaluation of cognitive functions...
December 20, 2016: Zhongguo Yi Xue Ke Xue Yuan Xue Bao. Acta Academiae Medicinae Sinicae
https://www.readbyqxmd.com/read/28018289/choroidal-and-retinal-abnormalities-by-optical-coherence-tomography-in-endogenous-cushing-s-syndrome
#4
Maria Fernanda Abalem, Marcio Carlos Machado, Helen Nazareth Veloso Dos Santos, Rafael Garcia, John Helal, Pedro Carlos Carricondo, Sérgio Luis Gianotti Pimentel, Mario Luiz Ribeiro Monteiro, Cynthia X Qian, Marcello Delano Bronstein, Maria Cândida Villares Barisson Fragoso
CONTEXT: Cortisol has been suggested as a risk factor for choroidal thickening, which may lead to retinal changes. OBJECTIVE: To compare choroidal thickness measurements using optical coherence tomography (OCT) in patients with endogenous active Cushing's syndrome (CS) and to evaluate the occurrence of retinal abnormalities in the same group of patients. DESIGN: Cross-sectional study. SETTING: Outpatient clinic. PATIENTS: Eleven female patients with CS in hypercortisolism state as determined by the presence of at least two abnormal measurements from urinary cortisol 24 h, no suppression of cortisol with low dose dexamethasone suppression test, and nocturnal salivary cortisol levels and 12 healthy controls...
2016: Frontiers in Endocrinology
https://www.readbyqxmd.com/read/28007845/cabergoline-for-cushing-s-disease-a-large-retrospective-multicenter-study
#5
Amandine Ferriere, Christine Cortet, Philippe Chanson, Brigitte Delemer, Philippe Caron, Olivier Chabre, Yves Reznik, Jerome Bertherat, Vincent Rohmer, Claire Briet, Isabelle Raingeard, Frédéric Castinetti, Albert Beckers, Laurent Vroonen, Dominique Maiter, Fritzline Cephise-Velayoudom, Marie-Laure Nunes, Magalie Haissaguerre, Antoine Tabarin
OBJECTIVE: The efficacy of cabergoline in Cushing's disease (CD) is controversial. The aim of this study was to assess the efficacy and tolerability of cabergoline in a large contemporary cohort of patients with CD. DESIGN: We conducted a retrospective multicenter study from thirteen French and Belgian university hospitals. METHODS: Sixty-two patients with CD received carbergoline monotherapy or add-on therapy. Symptom score, biological markers of hypercortisolism, and adverse effects were recorded...
December 22, 2016: European Journal of Endocrinology
https://www.readbyqxmd.com/read/28007534/fkbp5-polymorphism-is-associated-with-insulin-resistance-in-children-and-adolescents-with-obesity
#6
Marta Fichna, Izabela Krzyśko-Pieczka, Magdalena Żurawek, Bogda Skowrońska, Danuta Januszkiewicz-Lewandowska, Piotr Fichna
OBJECTIVE: Since metabolic syndrome shares several clinical features with hypercortisolism, it was hypothesised that genes altering individual glucocorticoid (GC) sensitivity might be implicated in pathogenesis of obesity and its adverse outcomes. FKBP5 gene encodes a chaperon protein in the GC receptor (GR) complex, which modulates steroid action upon target genes. Its functional variant, rs1360780, may enhance FKBP5 gene transcription, affect GR signalling and thereby influence the hypothalamo-pituitary-adrenal axis...
December 19, 2016: Obesity Research & Clinical Practice
https://www.readbyqxmd.com/read/28005257/safety-of-transsphenoidal-microsurgical-approach-in-patients-with-an-acth-secreting-pituitary-adenoma
#7
Carmine Antonio Donofrio, Marco Losa, Marco Gemma, Lodoviga Giudice, Lina Raffaella Barzaghi, Pietro Mortini
PURPOSE: Patients affected by Cushing's disease often have important comorbidities directly linked to hypercortisolism that might enhance the operative risk. We report the safety of transsphenoidal surgery in patients affected by Cushing's disease as compared with patients with nonfunctioning pituitary adenoma. METHODS: We have retrospectively analyzed 142 patients with Cushing's disease and 299 patients with nonfunctioning pituitary adenoma who underwent transsphenoidal surgery performed by a single experienced neurosurgeon between September 2007 and December 2014...
December 22, 2016: Endocrine
https://www.readbyqxmd.com/read/27999413/neuroprotection-via-reduction-in-stress-altered-menstrual-patterns-as-a-marker-for-stress-and-implications-for-long-term-neurologic-health-in-women
#8
REVIEW
David Prokai, Sarah L Berga
Individuals under chronic psychological stress can be difficult to identify clinically. There is often no outwardly visible phenotype. Chronic stress of sufficient magnitude not only impacts reproductive function, but also concomitantly elicits a constellation of neuroendocrine changes that may accelerate aging in general and brain aging in particular. Functional hypothalamic amenorrhea, a phenotypically recognizable form of stress, is due to stress-induced suppression of endogenous gonadotropin-releasing hormone secretion...
December 20, 2016: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/27986975/roles-of-hippocampal-somatostatin-receptor-subtypes-in-stress-response-and-emotionality
#9
Thomas D Prévôt, François Gastambide, Cécile Viollet, Nadia Henkousl, Guillaume Martel, Jacques Epelbaum, Daniel Béracochéa, Jean-Louis Guillou
Altered brain somatostatin functions recently appeared as key elements for the pathogenesis of stress related neuropsychiatric disorders. The hippocampus exerts an inhibitory feedback on stress but the mechanisms involved remain unclear. We investigated herein the role of hippocampal somatostatin receptor subtypes in both stress response and behavioral emotionality using C57BL/6, wild type and sst2 or sst4 knockout mice. Inhibitory effects of hippocampal infusions of somatostatin agonists on stress-induced hypothalamo-pituitary-adrenal axis (HPA) activity were tested by monitoring peripheral blood and local hippocampus corticosterone levels, the latter by using microdialysis...
December 16, 2016: Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology
https://www.readbyqxmd.com/read/27977570/hypokalemia-associated-with-a-solitary-pulmonary-nodule-a-case-report
#10
Samira Saeian, Seiyed Mohammad Ali Ghayumi, Mesbah Shams
BACKGROUND: Differential diagnosis of hypokalemia and adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome often presents challenging in endocrinology and requires careful clinical, biochemical, radiological, and pathological investigations. Hypokalemia is a common abnormality and systematic approach is required to avoid delays in diagnosis of important underlying causes. CASE SUMMARY & CONCLUSION: A 49-year-old woman presented with moderate hypokalemia...
December 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27974908/cushing-s-disease-a-multidisciplinary-overview-of-the-clinical-features-diagnosis-and-treatment
#11
REVIEW
A Buliman, L G Tataranu, D L Paun, A Mirica, C Dumitrache
Cushing's disease is considered a rare condition characterized by the hypersecretion of the adrenocorticotropic hormone (ACTH) due to a pituitary adenoma that ultimately causes endogenous hypercortisolism by stimulating the adrenal glands. The clinical signs suggesting Cushing's disease, such as obesity, moon face, hirsutism, and facial plethora are already present on presentation. Endogenous hypercortisolism is associated with an increased risk of cardiovascular and metabolic manifestations, as well as respiratory disorders, psychiatric complications, osteoporosis and infections, leading to high rates of morbidity and mortality...
January 2016: Journal of Medicine and Life
https://www.readbyqxmd.com/read/27973460/adrenal-disorders-and-nonalcoholic-fatty-liver-disease
#12
Labrini Papanastasiou, Stelios Fountoulakis, Ioannis A Vatalas
Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the developed world and its pathogenesis is complex and multifactorial. It is considered the hepatic manifestation of the metabolic syndrome and is the leading cause of hepatic cirrhosis. This review aims to present current knowledge on the involvement of the adrenal glands in the development of NAFLD. Clinical and animal studies have shown that excess glucocorticoids (GC) have been implicated in the pathogenesis of NAFLD. Patients with NAFLD seem to have a subtle chronic activation of the hypothalamic pituitary adrenal axis leading to a state of subclinical hypercortisolism...
December 14, 2016: Minerva Endocrinologica
https://www.readbyqxmd.com/read/27901643/bilateral-testicular-tumors-resulting-in-recurrent-cushing-s-syndrome-after-bilateral-adrenalectomy
#13
Troy Puar, Manon Engels, Antonius E van Herwaarden, Fred C G J Sweep, Christina Hulsbergen-van de Kaa, Karin Kamphuis-van Ulzen, Vasileios Chortis, Wiebke Arlt, Nike Stikkelbroeck, Hedi L Claahsen-van der Grinten, Ad R M M Hermus
CONTEXT: Recurrence of hypercortisolism in patients after bilateral adrenalectomy for Cushing's disease is extremely rare. PATIENT: We present a rare case of a 27-year-old man who previously underwent bilateral adrenalectomy for Cushing's disease with complete clinical resolution. Cushingoid features recurred 12 years later, along with bilateral testicular enlargement. Hormonal tests confirmed ACTH-dependent Cushing's. Surgical resection of the testicular tumors led to clinical and biochemical remission...
November 30, 2016: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/27869874/-pharmacological-treatment-in-adrenal-cushing-s-syndrome
#14
Antonio Stigliano, Lidia Cerquetti, Vincenzo Toscano
ACTH-independent adrenal Cushing's syndrome is the least common form of endogenous hypercortisolism. Recently, advances in genetics have allowed the description of several forms different to pathogenetic etiology, morphostructural characteristics and evolution towards the hypercortisolism. Alongside these, the adrenocortical carcinoma is also frequently responsible of a hypercortisolism clinical picture. The availability of steroidogenesis inhibitors, such as metyrapone and ketoconazole, provides to endocrinologist a therapeutic chance against different metabolic disorders sustained by hypercortisolism...
November 2016: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/27865591/outcome-of-adrenalectomy-for-subclinical-hypercortisolism-and-cushing-syndrome
#15
Marco Raffaelli, Carmela De Crea, Gerardo D'Amato, Pierpaolo Gallucci, Celestino P Lombardi, Rocco Bellantone
BACKGROUND: We compared operative and metabolic outcomes in patients with subclinical Cushing syndrome and Cushing syndrome caused by unilateral adrenal lesion, aiming to clarify the role of glucocorticoid replacement treatment in patients with subclinical Cushing syndrome after adrenalectomy. METHODS: The medical records of all the patients who underwent unilateral adrenalectomy for subclinical Cushing syndrome or Cushing syndrome were reviewed. Diagnostic criteria for subclinical Cushing syndrome were a pathologic dexamethasone suppression test plus 2 additional criteria...
January 2017: Surgery
https://www.readbyqxmd.com/read/27859451/altered-spontaneous-brain-activity-in-cushing-s-disease-a-resting-state-functional-mri-study
#16
Hong Jiang, Na-Ying He, Yu-Hao Sun, Fang-Fang Jian, Liu-Guan Bian, Jian-Kang Shen, Fu-Hua Yan, Si-Jian Pan, Qing-Fang Sun
CONTEXT AND OBJECTIVE: Cushing's disease (CD) provides a unique and naturalist model for studying the influence of hypercortisolism on the human brain and the reversibility of these effects after resolution of the condition. This cross-sectional study used resting-state fMRI (rs-fMRI) to investigate the altered spontaneous brain activity in CD patients and the trends for potential reversibility after the resolution of the hypercortisolism. We also aim to determine the relationship of these changes with clinical characteristics and cortisol levels...
November 8, 2016: Clinical Endocrinology
https://www.readbyqxmd.com/read/27857836/refractory-hypoglycemia-in-a-patient-with-functional-adrenal-cortical-carcinoma
#17
Katia Regina Marchetti, Maria Adelaide Albergaria Pereira, Arnaldo Lichtenstein, Edison Ferreira Paiva
: Adrenacarcinomas are rare, and hypoglycemic syndrome resulting from the secretion of insulin-like growth factor II (IGF-II) by these tumors have been described infrequently. This study describes the case of a young woman with severe persistent hypoglycemia and a large adrenal tumor and discusses the physiopathological mechanisms involved in hypoglycemia. The case is described as a 21-year-old woman who presented with 8 months of general symptoms and, in the preceding 3 months, with episodes of mental confusion and visual blurring secondary to hypoglycemia...
2016: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/27797672/low-dheas-a-sensitive-and-specific-test-for-detection-of-subclinical-hypercortisolism-in-adrenal-incidentalomas
#18
Michael Conall Dennedy, Anand K Annamalai, Olivia Prankerd Smith, Natalie Freeman, Kuhan Vengopal, Johann Graggaber, Olympia Koulouri, Andrew S Powlson, Ashley Shaw, David J Halsall, Mark Gurnell
CONTEXT: Subclinical hypercortisolism (SH) occurs in 5-30% of adrenal incidentalomas (AIs). Common screening tests for adrenocorticotropin (ACTH)-independent hypercortisolism have significant false positive rates, mandating further time and resource intensive investigations. OBJECTIVE: To determine whether low basal dehydroepiandrosterone sulphate (DHEAS) is a sensitive and specific screening test for SH in AI. SETTING AND PATIENTS: 185 patients with AI were screened for adrenal medullary (plasma metanephrines) and cortical [1 mg overnight dexamethasone suppression test (ONDST), 24h urinary free cortisol (UFC), serum DHEAS, plasma renin and aldosterone] hyperfunction...
October 31, 2016: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/27766686/treatment-related-neuroendocrine-prostate-cancer-resulting-in-cushing-s-syndrome
#19
Sundhar Ramalingam, Adva Eisenberg, Wen Chi Foo, Jennifer Freedman, Andrew J Armstrong, Larry G Moss, Michael R Harrison
Here we present, to the best of our knowledge, the first case of a paraneoplastic Cushing's syndrome (hypercortisolism) resulting from treatment-related neuroendocrine prostate cancer - a highly aggressive and difficult disease to treat. A 51-year-old man was started on androgen deprivation therapy after presenting with metastatic prostate cancer, characterized by diffuse osseous metastasis. Shortly thereafter, he developed progressive disease with biopsy proven neuroendocrine prostate cancer as well as symptoms of increased skin pigmentation, hypokalemia, hypertension, hyperglycemia and profound weakness, consistent with ectopic Cushing's syndrome...
December 2016: International Journal of Urology: Official Journal of the Japanese Urological Association
https://www.readbyqxmd.com/read/27759849/long-term-results-after-ct-guided-percutaneous-ethanol-ablation-for-the-treatment-of-hyperfunctioning-adrenal-disorders
#20
Nathan Elie Frenk, Fernando Sebastianes, Antonio Marcondes Lerario, Maria Candida Barisson Villares Fragoso, Berenice Bilharinho Mendonca, Marcos Roberto de Menezes
OBJECTIVES: To evaluate the safety and long-term efficacy of computed tomography-guided percutaneous ethanol ablation for benign primary and secondary hyperfunctioning adrenal disorders. METHOD: We retrospectively evaluated the long-term results of nine patients treated with computed tomography-guided percutaneous ethanol ablation: eight subjects who presented with primary adrenal disorders, such as pheochromocytoma, primary macronodular adrenal hyperplasia and aldosterone-producing adenoma, and one subject with Cushing disease refractory to conventional treatment...
October 1, 2016: Clinics
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