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https://www.readbyqxmd.com/read/29765354/pituitary-directed-therapies-for-cushing-s-disease
#1
REVIEW
Fabienne Langlois, Jennifer Chu, Maria Fleseriu
Cushing's disease (CD) is caused by a pituitary corticotroph neuroendocrine tumor inducing uncontrolled hypercortisolism. Transsphenoidal surgery is the first-line treatment in most cases. Nonetheless, some patients will not achieve cure even in expert hands, others may not be surgical candidates and a significant percentage will experience recurrence. Many patients will thus require medical therapy to achieve disease control. Pharmacologic options to treat CD have increased in recent years, with an explosion in knowledge related to pathophysiology at the molecular level...
2018: Frontiers in Endocrinology
https://www.readbyqxmd.com/read/29755405/dual-paraneoplastic-endocrine-syndromes-heralding-onset-of-extrapulmonary-small-cell-carcinoma-a-case-report-and-narrative-review
#2
Jill B Feffer, Natalia M Branis, Jeanine B Albu
Objective: Extrapulmonary small cell carcinoma (EPSCC) is rare and frequent metastases at presentation can complicate efforts to identify a site of origin. In particular, SCC comprises <1% of prostate cancers and has been implicated in castration resistance. Methods: Clinical, laboratory, imaging, and pathology data are presented. Results: A 56-year-old man with locally advanced prostate adenocarcinoma on androgen deprivation therapy presented with a clogged nephrostomy tube...
2018: Frontiers in Endocrinology
https://www.readbyqxmd.com/read/29754643/pregnancy-in-patients-with-cushing-s-syndrome
#3
REVIEW
Marcio Carlos Machado, Maria Candida Barisson Vilares Fragoso, Marcello Delano Bronstein
Progress in diagnosis and treatment of endocrine diseases has made pregnancy possible for women with endocrinopathies, including Cushing's syndrome (CS). The risk of maternal-fetal complications in patients who are not biochemically controlled, however, is substantial. Therefore, the surgical and/or medical control of hypercortisolism is mandatory prior to conceiving. A diagnosis of de novo CS during gestation is difficult due to changes in the hypothalamic-pituitary-adrenal axis during pregnancy, which may lead to some clinical features suggestive of CS along with abnormal laboratory tests...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754640/adrenocortical-carcinoma-with-hypercortisolism
#4
REVIEW
Soraya Puglisi, Paola Perotti, Anna Pia, Giuseppe Reimondo, Massimo Terzolo
Adrenocortical carcinoma (ACC) is a rare and aggressive tumor. ACC may be associated with different syndromes of hormone excess, most frequently Cushing's syndrome with or without hypersecretion of androgens. Recent data suggest that cortisol excess is a negative prognostic factor in advanced and localized ACC. Surgery with radical intent, when feasible, is the most effective treatment for ACC with hypercortisolism. Mitotane is the medical treatment of choice, both postoperatively and in inoperable or metastatic cases...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754639/adrenal-surgery-for-cushing-s-syndrome-an-update
#5
REVIEW
Guido Di Dalmazi, Martin Reincke
Recent advances in the molecular pathogenesis and the natural history of Cushing's syndrome have improved the understanding of the management of this disease. The long-term efficacy of several cortisol-lowering medical treatments is currently under evaluation. However, adrenalectomy is a safe option for the treatment of patients affected by Cushing's syndrome. Unilateral adrenalectomy is the gold standard for treatment of adrenocortical adenomas associated with hypercortisolism. Bilateral adrenalectomy has been widely used in the past as definitive treatment of bilateral macronodular hyperplasia and persistent or recurrent Cushing's disease...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754638/recent-advances-on-subclinical-hypercortisolism
#6
REVIEW
Guido Zavatta, Guido Di Dalmazi
During the last 20 years, a significant body of literature has accumulated regarding subclinical hypercortisolism in patients with adrenal incidentalomas. Retrospective studies have indicated these patients have an increase in cardiovascular events and mortality. Current recommendations for patients with adrenal incidentalomas include an overnight low-dose dexamethasone suppression test and a thorough evaluation of cardiovascular and metabolic risk factors. Further hormonal testing and close monitoring are necessary in patients with incomplete suppression...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754633/morbidity-of-cushing-s-syndrome-and-impact-of-treatment
#7
REVIEW
Susan M Webb, Elena Valassi
Cortisol excess in Cushing's syndrome is associated with metabolic, cardiovascular, and cognitive alterations, only partially reversible after resolution of hypercortisolism. Elevated cardiovascular risk may persist after eucortisolism has been achieved. Fractures and low bone mineral density are also described in Cushing's syndrome in remission. Hypercortisolism may induce irreversible structural and functional changes in the brain, leading to neuropsychiatric disorders in the active phase of the disease, which persist...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754631/diagnosis-of-cushing-s-syndrome-in-the-modern-era
#8
REVIEW
Lynnette Kaye Nieman
Four challenges complicate the evaluation for Cushing syndrome. These challenges include increasing global prevalence of obesity and diabetes; increasing use of exogenous glucocorticoids, which cause a Cushing syndrome phenotype; the confusion caused by nonpathologic hypercortisolism not associated with Cushing syndrome, which may present with symptoms consistent with Cushing syndrome; and difficulty identifying pathologic hypercortisolism when it is extremely mild or cyclic or in renal failure, incidental adrenal masses, and pregnancy...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29749133/characteristics-of-adrenal-incidentalomas-in-a-large-prospective-computed-tomography-based-multicenter-study-the-coar-study-in-korea
#9
Seong Hee Ahn, Jae Hyeon Kim, Seung Hee Baek, Hyeonmok Kim, Yoon Young Cho, Sunghwan Suh, Beom Jun Kim, Seongbin Hong, Jung Min Koh, Seung Hun Lee, Kee Ho Song
PURPOSE: Previous studies on adrenal incidentalomas (AIs) are limited by their retrospective design, small numbers of patients, Western populations, or use of an outdated imaging technique. We investigated the characteristics of AIs in Korean patients and compared them with those reported in the largest retrospective study in Italy to discover the effects of improved imaging techniques and ethnicity differences. MATERIALS AND METHODS: This was a prospective, multicenter, cross-sectional observational study including 1005 Korean patients...
June 2018: Yonsei Medical Journal
https://www.readbyqxmd.com/read/29721436/overexpression-of-11%C3%AE-hydroxysteroid-dehydrogenase-1-in-visceral-adipose-tissue-and-underexpression-of-endothelial-nitric-oxide-synthase-in-the-adrenal-cortex-of-dogs-with-hyperadrenocorticism
#10
Diego Daniel Miceli, Adriana María Belén Abiuso, Patricia Noemi Vidal, María Florencia Gallelli, Omar Pedro Pignataro, Victor Alejandro Castillo
11β-Hydroxysteroid dehydrogenase 1 (11β-HSD1) is an enzyme that activates cortisone into cortisol in tissues. Alterations in this enzyme are related to the development of metabolic syndrome, obesity and hyperadrenocorticism (HAC). Endothelial nitric oxide synthase (eNOS) produces nitric oxide and is related to the regulation of adrenal steroidogenesis. The aim of the study was to evaluate 11β-HSD1 and eNOS expression in dogs with HAC. Visceral adipose tissue samples were taken to evaluate 11β-HSD1 expression by immunohistochemistry and western blotting...
2018: Open Veterinary Journal
https://www.readbyqxmd.com/read/29719879/low-dose-and-standard-overnight-and-low-dose-two-day-dexamethasone-suppression-tests-in-patients-with-mild-and-or-episodic-hypercortisolism
#11
Mona Mojtahedzadeh, Nesyah Shaesteh, Mastaneh Haykani, Jennifer L A Tran, Michael Mangubat, Hraya K Shahinian, Rahul Nachnani, Mohan Zopey, Jason Saidian, Antolice Thomas, Martin L Lee, Ian E McCutcheon, Theodore C Friedman
We previously reported on the lack of utility of the 1 mg overnight dexamethasone (DEX) test in mild and/or periodic Cushing's syndrome, as most patients with the condition suppressed to 1 mg DEX. It is possible that a lower dose of DEX as part of an overnight DEX test might be able to distinguish between mild and/or periodic Cushing's syndrome and those without the condition. The objective of the current study is to determine the sensitivity and specificity of a 0.25 mg overnight DEX suppression test, the standard 1 mg overnight DEX suppression test, and the two-day low-dose (Liddle test) DEX suppression test with and without correction for DEX levels in patients evaluated for mild and/or periodic Cushing's syndrome...
May 2, 2018: Hormone and Metabolic Research, Hormon- und Stoffwechselforschung, Hormones et Métabolisme
https://www.readbyqxmd.com/read/29717464/alteration-in-skeletal-muscle-mass-in-women-with-subclinical-hypercortisolism
#12
Jae Hyeon Kim, Mi Kyung Kwak, Seong Hee Ahn, Hyeonmok Kim, Yoon Young Cho, Sunghwan Suh, Beom-Jun Kim, Kee-Ho Song, Seung Hun Lee, Jung-Min Koh
PURPOSE: Despite the well-known deleterious effects of cortisol on skeletal muscle, whether subtle cortisol excess in subclinical hypercortisolism (SH) affects skeletal muscle mass is unknown. Our objective was to understand the effects of the cortisol level on skeletal muscle mass in patients with SH. METHODS: We compared skeletal muscle mass and fat mass (FM) between 21 patients with SH (12 women and 9 men) and 224 controls (67 women and 157 men) with nonfunctioning adrenal incidentaloma (NFAI)...
May 1, 2018: Endocrine
https://www.readbyqxmd.com/read/29716804/root-cause-analysis-of-diagnostic-and-surgical-failures-in-the-treatment-of-suspected-cushing-s-disease
#13
Hasan A Zaidi, David L Penn, David J Cote, Edward R Laws
Cushing's disease (CD) is a condition characterized by excess glucocorticoid from an ACTH pituitary adenoma. Identifying surgical candidates represents a major diagnostic challenge. We performed a root cause analysis (RCA) of treatment failures for patients with suspected CD. The present study aims to categorize failures in treatment. Medical records were reviewed from 2008 to 2017 for all patients treated surgically for suspected CD. Demographics, past medical history, endocrine outcomes, imaging findings, laboratory studies and clinical features were collected...
April 28, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29716734/the-difficulties-of-pseudo-cushing-s-syndrome-or-non-neoplastic-hypercortisolism
#14
Olivier Chabre
Pseudo-Cushing's syndrome covers different pathological conditions responsible for mild-to-moderate ACTH-dependent hypercortisolism, related not to an ACTH-secreting tumor but rather to CRH and/or AVP hypothalamic secretion through activation of various neural pathways, in patients generally displaying excess central adiposity. It is better termed "non-neoplastic hypercortisolism" (NNH). The main conditions implicated in NNH comprise: neuropsychiatric disorder, alcohol abuse, insulin-resistant obesity, polycystic ovary syndrome, and end-stage kidney disease...
April 28, 2018: Annales D'endocrinologie
https://www.readbyqxmd.com/read/29694638/a-review-of-cushing-s-disease-treatment-by-the-department-of-neuroendocrinology-of-the-brazilian-society-of-endocrinology-and-metabolism
#15
Márcio Carlos Machado, Maria Candida Barisson Vilares Fragoso, Ayrton Custódio Moreira, César Luiz Boguszewski, Leonardo Vieira Neto, Luciana A Naves, Lucio Vilar, Luiz Antônio de Araújo, Nina Rosa Castro Musolino, Paulo Augusto C Miranda, Mauro A Czepielewski, Monica R Gadelha, Marcello Delano Bronstein, Antônio Ribeiro-Oliveira
The treatment objectives for a patient with Cushing's disease (CD) are remission of hypercortisolism, adequate management of co-morbidities, restoration of the hypothalamic-pituitary-adrenal axis, preservation of fertility and pituitary function, and improvement of visual defects in cases of macroadenomas with suprasellar extension. Transsphenoidal pituitary surgery is the main treatment option for the majority of cases, even in macroadenomas with low probability of remission. In cases of surgical failure, another subsequent pituitary surgery might be indicated in cases with persistent tumor imaging at post surgical magnetic resonance imaging (MRI) and/or pathology analysis of adrenocorticotropic hormone-positive (ACTH+) positive pituitary adenoma in the first procedure...
February 2018: Archives of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/29685454/pathophysiology-of-glucocorticoid-signaling
#16
Géraldine Vitellius, Séverine Trabado, Jérôme Bouligand, Brigitte Delemer, Marc Lombès
Glucocorticoids (GC), such as cortisol or dexamethasone, control various physiological functions, notably those involved in development, metabolism, inflammatory processes and stress, and exert most of their effects upon binding to the glucocorticoid receptor (GR, encoded by NR3C1 gene). GC signaling follows several consecutive steps leading to target gene transactivation, including ligand binding, nuclear translocation of ligand-activated GR complexes, DNA binding, coactivator interaction and recruitment of functional transcriptional machinery...
April 20, 2018: Annales D'endocrinologie
https://www.readbyqxmd.com/read/29672894/unexpected-adverse-effect-of-metyrapone-a-case-report
#17
LETTER
Alexia Rouland, Amandine Nguyen, Coralie Fourmont, Marion Lapray, Bruno Vergès, Jean Michel Petit, Benjamin Bouillet
No abstract text is available yet for this article.
April 19, 2018: Clinical Endocrinology
https://www.readbyqxmd.com/read/29667589/a-rare-cause-of-dysregulated-metabolic-syndrome-cortisol-producing-adrenocortical-carcinoma
#18
L Saes, I A Boere, J Hofland, M Mulder, R A Feelders
Adrenocortical carcinoma is a rare and highly malignant disease which can cause hypercortisolism leading to dysregulation of blood pressure and glucose levels. Most patients present with advanced disease. We describe the classic presentation of a functional adrenocortical carcinoma in a patient with metabolic syndrome.
April 2018: Netherlands Journal of Medicine
https://www.readbyqxmd.com/read/29661471/do-the-diagnostic-criteria-for-subclinical-hypercortisolism-exist
#19
Antoine Tabarin
"Subclinical hypercortisolism" (SH) refers to a condition associated with a mild chronic increase in cortisol secretion. By definition, patients with SH do not exhibit specific symptoms of overt Cushing's syndrome (such as purple striae, easy bruising, proximal muscle weakness), SH has been preferred to "subclinical Cushing's syndrome", a semantic ambiguity since Cushing's syndrome is, by definition, a set of symptoms; and to the term "preclinical Cushing syndrome" because the progression toward overt clinical hypercortisolism is very rare...
April 13, 2018: Annales D'endocrinologie
https://www.readbyqxmd.com/read/29655957/ectopic-cushing-syndrome-report-of-9-cases
#20
Marta Araujo Castro, Nuria Palacios García, Javier Aller Pardo, Cristina Izquierdo Alvarez, Laura Armengod Grao, Javier Estrada García
INTRODUCTION: Ectopic Cushing's syndrome (ECS) is a rare condition caused by ACTH secretion by extrapituitary tumors. Its low frequency makes it difficult to acquire experience in its management. The aim of this study was to describe patients with ECS seen at the endocrinology department of a tertiary hospital over 15 years. METHODS: This was a retrospective study of the clinical, biochemical and radiographic data, treatment, and course of patients with ECS seen from 2000 to 2015...
April 11, 2018: Endocrinología, Diabetes y Nutrición
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