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cushing s disease

D A Vassiliadi, M Balomenaki, A Asimakopoulou, E Botoula, M Tzanela, S Tsagarakis
CONTEXT: Cushing's disease (CD) has a significant relapse rate after successful transsphenoidal surgery (TSS). Many CD patients respond aberrantly to desmopressin testing (DT). Disappearance of this response post-surgery may suggest complete removal of abnormal corticotrophs and lower possibility of recurrence. OBJECTIVE: The utility of post-operative DT to predict long-term outcome compared to the widely used post-operative cortisol (Cort) level. DESIGN: Retrospective analysis...
September 23, 2016: Journal of Clinical Endocrinology and Metabolism
Jeffrey Wagner, Cara M Fleseriu, Aly Ibrahim, Justin S Cetas
BACKGROUND: Idiopathic intracranial hypertension (IIH) in patients with Cushing disease (CD), after treatment, is rarely described, in adults. The cause is believed to be multifactorial, potentially related to a relative decrease in cortisol after surgical resection or medical treatment of a corticotroph pituitary adenoma. We investigate our center's CD database (140 surgically and 60 medically [primary or adjunct] treated patients) for cases of IIH, describe our center's experience with symptomatic IIH, and review treatment strategies in adults with CD after transsphenoidal resection...
September 12, 2016: World Neurosurgery
Maem Wagenmakers, Shpp Roerink, Tha Schreuder, T S Plantinga, S Holewijn, Dhj Thijssen, J W Smit, G A Rongen, A M Pereira, Ajm Wagenmakers, R T Netea-Maier, Armm Hermus
CONTEXT: In active Cushing's syndrome (CS), patients suffer from endothelial dysfunction and premature atherosclerosis. However, it is uncertain to what extent vascular health recovers after long-term remission. This is highly relevant as this topic relates to future development of cardiovascular disease. OBJECTIVE: To investigate whether micro- and macrovascular health is impaired after long-term remission of CS, in patients with no or adequately treated co-morbidities...
August 23, 2016: Journal of Clinical Endocrinology and Metabolism
Michael A Mooney, Elias D Simon, Andrew S Little
The current treatment of pituitary adenomas requires a balance of conservative management, surgical resection, and in select tumor types, molecular therapy. Acromegaly treatment is an evolving field where our understanding of molecular targets and drug therapies has improved treatment options for patients with excess growth hormone levels. We highlight the use of molecular therapies in this disease process and advances in this field, which may represent a paradigm shift for the future of pituitary adenoma treatment...
2016: Frontiers in Surgery
L Lu, J H Chen, H J Zhu, A L Song, M Li, S Chen, H Pan, F Y Gong, R Z Wang, B Xing, Y Yao, M Feng, Z L Lu
OBJECTIVE: To compare the sensitivity and specificity between the 24 hour urine free cortisol (24 h UFC) and serum cortisol in dexamethasone suppression test (DST) in the diagnosis of Cushing syndrome (CS). METHODS: Combined low dose DST (LDDST) and high dose DST (HDDST) were carried out in 67 cases of CS with surgically confirmed cases in recent 3 years(from January 2011 to November 2015). The serum cortisol and 24 h UFC were collected simultaneously for each subject and the sensitivity and specificity of serum cortisol and 24 h UFC were compared...
July 19, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Afif Nakhleh, Leonard Saiegh, Maria Reut, Mohammad Sheikh Ahmad, Irit Wirsansky Pearl, Carmela Shechner
OBJECTIVE: Cushing`s disease during pregnancy is associated with an increased risk for maternal and fetal complications. In recurrent Cushing`s disease following transsphenoidal surgery, and when re-operation is not feasible, medical treatment is usually considered. Cabergoline was found to be effective in reducing hypercortisolism in Cushing's disease. Evolving data concerning the safety of cabergoline use during pregnancy show no significant increase in the rate of complications during pregnancy or the postnatal period...
July 11, 2016: Hormones: International Journal of Endocrinology and Metabolism
M C Machado, A E E Alcantara, A C L Pereira, V A S Cescato, N R Castro Musolino, B B de Mendonça, M D Bronstein, M C B V Fragoso
PURPOSE: Pituitary macroadenomas (MACs) represent 10-30 % of Cushing's disease (CD) cases. The aim of this study was to report the clinical, laboratorial and imaging features and postsurgical outcomes of microadenoma (MIC) and MAC patients. METHODS: Retrospective study with 317 CD patients (median 32 years old, range 9-71 years) admitted between 1990 and 2014, 74 (23.3 %) of whom had MAC. RESULTS: Hirsutism, plethora facial, muscular weakness and muscular atrophy were more frequent in the MIC patients...
June 30, 2016: Journal of Endocrinological Investigation
A Pazderska, S Crowther, P Govender, K C Conlon, M Sherlock, J Gibney
UNLABELLED: Avascular necrosis (AVN) is a rare presenting feature of endogenous hypercortisolism. If left untreated, complete collapse of the femoral head may ensue, necessitating hip replacement in up to 70% of patients. The majority of the described patients with AVN due to endogenous hypercortisolaemia required surgical intervention. A 36-year-old female, investigated for right leg pain, reported rapid weight gain, bruising and secondary amenorrhoea. She had abdominal adiposity with violaceous striae, facial plethora and hirsutism, atrophic skin, ecchymosis and proximal myopathy...
2016: Endocrinology, Diabetes & Metabolism Case Reports
Martin G Radvany, Alfredo Quinones-Hinojosa, Gary L Gallia, Gary S Wand, Roberto Salvatori
OBJECTIVE: Because magnetic resonance imaging (MRI) fails to detect many adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas, inferior petrosal sinus sampling (IPSS) is considered the gold standard to differentiate Cushing disease (CD) from ectopic ACTH secretion syndrome (EAS). Some authors have suggested internal jugular vein sampling (IJVS) as an alternative to IPSS. METHODS: We simultaneously compared IJVS to IPSS in 30 consecutive patients referred for ACTH-dependent Cushing syndrome and equivocal MRI exams...
September 2016: Endocrine Practice
Christopher C Cushing, Bruno Martinez-Leo, Alberto Peña, Andrea Bischoff, Jennifer Hall, Michael Helmrath, Belinda Hsi Dickie, Marc A Levitt, Meg H Zeller, Jason S Frischer
OBJECTIVE: To describe the quality of life and parenting stress associated with a child with fecal incontinence (FI). METHODS: Female caregivers (n = 170) of children aged 3-12 with FI completed a broad and general measure of quality of life and a measure of parenting stress. Results were compared to proxy reports for a normative sample of healthy children. RESULTS: Caregivers of children with FI reported significantly impaired quality of life for their children and increased parenting stress in all of the respective domains relative to healthy controls...
March 23, 2016: Journal of Pediatric Gastroenterology and Nutrition
S Nader, T Burkhardt, E Vettorazzi, M Milian, J Aberle, S Petersenn, J Flitsch
BACKGROUND: Patients suffering from Cushing's disease are known to be restricted due to a wide range of symptoms. Despite biochemical cure, symptoms might last life-long. These include - among well-known somatic symptoms - several neuropsychiatric symptoms that cannot be as easily tested, but lead to a serious negative impact on quality of life. We aimed to evaluate what factors diminish the self-perceived quality of life the most using 3 questionnaires visualizing those impairments. Furthermore we investigated whether there would be differences in quality of life between patients still being affected by the disease and those that are already in remission...
March 2016: Experimental and Clinical Endocrinology & Diabetes
Prashant Chittiboina, S Lalith Talagala, Hellmut Merkle, Joelle E Sarlls, Blake K Montgomery, Martin G Piazza, Gretchen Scott, Abhik Ray-Chaudhury, Russell R Lonser, Edward H Oldfield, Alan P Koretsky, John A Butman
OBJECTIVE Pituitary MR imaging fails to detect over 50% of microadenomas in Cushing's disease and nearly 80% of cases of dural microinvasion. Surface coils can generate exceptionally high-resolution images of the immediately adjacent tissues. To improve imaging of the pituitary gland, a receive-only surface coil that can be placed within the sphenoid sinus (the endosphenoidal coil [ESC]) during transsphenoidal surgery (TSS) was developed and assessed. METHODS Five cadaver heads were used for preclinical testing of the ESC...
March 18, 2016: Journal of Neurosurgery
Giampaolo Trivellin, Ricardo R Correa, Maria Batsis, Fabio R Faucz, Prashant Chittiboina, Ivana Bjelobaba, Darwin O Larco, Martha Quezado, Adrian F Daly, Stanko S Stojilkovic, T John Wu, Albert Beckers, Maya Lodish, Constantine A Stratakis
Cushing disease (CD) in children is caused by adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas. Germline or somatic mutations in genes such as MEN1, CDKIs, AIP, and USP8 have been identified in pediatric CD, but the genetic defects in a significant percentage of cases are still unknown. We investigated the orphan G protein-coupled receptor GPR101, a gene known to be involved in somatotropinomas, for its possible involvement in corticotropinomas. We performed GPR101 sequencing, expression analyses by RT-qPCR and immunostaining, and functional studies (cell proliferation, pituitary hormones secretion, and cAMP measurement) in a series of patients with sporadic CD secondary to ACTH-secreting adenomas in whom we had peripheral and tumor DNA (N=36)...
March 9, 2016: Endocrine-related Cancer
Lichun Sun, David H Coy
Somatostatin (SST) is a cyclic hormone-release inhibitory peptide that has high binding affinity to all of its five SST receptors (SSTRs). SST negatively regulates cell proliferation and the release of multiple hormones via activation of its cognate receptors. A variety of SST analogs, some with high affinity and selectivity of receptor subtypes, have been synthesized and developed. Certain long-acting SST analogs such as octreotide, lanreotide and pasireotide have been clinically applied to the treatment of human diseases such as those caused by excessive release of growth hormone (acromegaly), or adrenocorticotropic hormone (Cushing's syndrome), and for the treatment of carcinoid syndrome...
2016: Current Drug Targets
Dan Louie Renz P Tating, Natasha Denise S Montevirgen, Loyda Cajucom
Cushing's syndrome is a state of cortisol excess, possibly from a tumor in the pituitary gland, the adrenal gland, or an ectopic nonpituitary ACTH-secreting source. The first form, pituitary in origin, was originally described by Harvey Cushing, MD, and was labeled as Cushing's disease. Long-term therapy with glucocorticoids also can lead to iatrogenic Cushing's syndrome.
March 2016: Oncology Nursing Forum
Przemysław Witek, Grzegorz Zieliński, Katarzyna Szamotulska, Joanna Witek, Grzegorz Kamiński
INTRODUCTION: Effective transsphenoidal surgery (TSS) for Cushing`s disease (CD) normalizes cortisol levels and reduces complications of hypercortisolism. However, there is evidence of increased cardiovascular morbidity even after successful surgery. OBJECTIVE: A prospective, controlled study on the dynamics of fibrinogen and D-dimer levels with a six-month follow-up after an effective TSS for CD. MATERIAL AND METHODS: Forty patients with CD and forty healthy age- and sex-matched subjects were included...
2016: Endokrynologia Polska
Michael S Broder, Eunice Chang, Dasha Cherepanov, Maureen P Neary, William H Ludlam
OBJECTIVE: Cushing disease (CD) causes a wide variety of nonspecific symptoms, which may result in delayed diagnosis. It may be possible to uncover unusual combinations of otherwise common symptoms using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Our aim was to identify and evaluate dyads of clinical symptoms or conditions associated with CD. METHODS: We conducted a matched case-control study using a commercial healthcare insurance claims database designed to compare the relative risk (RR) of individual conditions and dyad combinations of conditions among patients with CD versus matched non-CD controls...
May 2016: Endocrine Practice
S M I Zaidi, A Nassimizadeh, A Warfield, A P Johnson, S K Ahmed
The Codman ETHISORB Dura Patch is a synthetic, absorbable material whose absorption is complete within approximately 90 days. We report the first case of an unabsorbed Codman Dura patch, in which a patient was presented with nasal obstruction and epistaxis 8 years after pituitary surgery for Cushing's disease.
January 13, 2016: British Journal of Neurosurgery
H H Loh, A Yee, H S Loh, N Sukor, N A Kamaruddin
PURPOSE: Long-term outcome of patients with adrenal incidentaloma (AI) is unknown. The aim of this study was to systematically summarize the follow-up and outcome of clinically silent AI who do not undergo surgery. METHODS: All major databases and medical literature in English-language, published from 1998 to May 2015, were systematically searched for publications on AI. Primary endpoint was hormonal hyper function; secondary endpoints were time from diagnosis to study endpoint and the outcome of adrenalectomy...
December 23, 2015: Minerva Endocrinologica
O P Prajapati, A K Verma, A Mishra, G Agarwal, A Agarwal, S K Mishra
AIM: To assess the outcome of patients undergoing bilateral adrenalectomy for Cushing's syndrome (CS). METHODS: All patients who underwent bilateral adrenalectomy for CS at the Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences hospital between 1991 and 2013 were included. Medical records were reviewed to obtain patient characteristics and follow-up data. RESULTS: Twenty-seven patients were studied. Mean age was 28...
November 2015: Indian Journal of Endocrinology and Metabolism
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