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https://www.readbyqxmd.com/read/29716734/the-difficulties-of-pseudo-cushing-s-syndrome-or-non-neoplastic-hypercortisolism
#1
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/29472379/diagnosis-of-endocrine-disease-the-role-of-the-desmopressin-test-in-the-diagnosis-and-follow-up-of-cushing-s-syndrome
#2
REVIEW
Dimitra Argyro Vassiliadi, Stylianos Tsagarakis
Desmopressin is a vasopressin analogue selective for type 2 vasopressin receptors that mediate renal water retention. In contrast to the native hormone arginine vasopressin, a well-known ACTH secretagogue, desmopressin, exerts minimal or no activity on ACTH excretion. However, in a substantial proportion of patients with ACTH-dependent Cushing's syndrome (CS), desmopressin elicits an ACTH and cortisol response, which contrasts with the minimal responses obtained in healthy subjects. The mechanism underlying this paradoxical response involves upregulation of vasopressin type 3 and/or the aberrant expression of type 2 receptors by neoplastic ACTH-producing cells...
May 2018: European Journal of Endocrinology
https://www.readbyqxmd.com/read/29450857/hypokalemia-associated-with-pseudo-cushing-s-syndrome-and-magnesium-deficiency-induced-by-chronic-alcohol-abuse
#3
Masafumi Kurajoh, Keiko Ohsugi, Miki Kakutani-Hatayama, Takuhito Shoji, Hidenori Koyama
Hypokalemia and hypomagnesemia are frequently observed in patients with chronic alcoholism. However, the involvement of deranged cortisol regulation in patients with those conditions has not been reported. A 63-year-old Japanese male with chronic alcoholism was referred to the Department of Diabetes, Endocrinology and Metabolism for examination and treatment of hypokalemic periodic paralysis. Laboratory findings showed hypokalemia (2.3 mmol/l), as well as a high level of urinary excretion of potassium and hypomagnesemia (1...
May 2018: CEN Case Reports
https://www.readbyqxmd.com/read/29212586/hypercortisolemia-and-depressive-like-behaviors-in-a-rhesus-macaque-macaca-mulatta-involved-in-visual-research
#4
Sean C Adams, Christine M Guyot, Kristina M Berry, Seth T Wallack, Andrew S Loar, Mathias Leblanc
A 10-y-old cranially implanted rhesus macaque (Macaca mulatta) involved in visual research was presented for dull mentation and weight loss. Physical examination revealed alopecia and poor body conditioning, and bloodwork revealed marked hypercortisolemia (23 μg/dL). Differential diagnoses for hypercortisolemia, weight loss, and alopecia included Cushing and pseudo-Cushing syndromes. To further evaluate hypercortisolemia, we compared the urine cortisol:creatinine ratio (UCCR) at baseline and after low-dose dexamethasone suppression (LDDS) testing in the presenting animal and healthy naïve and implanted working monkeys...
December 1, 2017: Comparative Medicine
https://www.readbyqxmd.com/read/29144801/utility-of-a-single-late-night-plasma-cortisol-and-acth-for-the-diagnosis-of-cushing-syndrome
#5
Kush Dev Singh Jarial, Anil Bhansali, Kanchan K Mukherjee, Rimesh Pal, Akhilesh Sharma, Rakesh K Vashishtha, Suja P Sukumar, Naresh Sachdeva, Rama Walia
OBJECTIVE: To evaluate the diagnostic efficacy of various screening tests for the diagnosis of Cushing syndrome (CS). METHODS: Thirty-five patients with CS and 16 patients of pseudo-CS were enrolled. Assessment of 24-h urinary free cortisol (UFC), late-night salivary cortisol (LNSC), overnight dexamethasone suppression test (ONDST), late-night plasma cortisol (LNPC), and adrenocorticotropic hormone (ACTH) on outpatient basis, and during sleep as well as in awake state after 48 hours of hospital admission...
February 2018: Endocrine Practice
https://www.readbyqxmd.com/read/28179447/diagnosis-of-endocrine-disease-differentiation-of-pathologic-neoplastic-hypercortisolism-cushing-s-syndrome-from-physiologic-non-neoplastic-hypercortisolism-formerly-known-as-pseudo-cushing-s-syndrome
#6
REVIEW
James W Findling, Hershel Raff
Endogenous hypercortisolism (Cushing's syndrome) usually implies the presence of a pathologic condition caused by either an ACTH-secreting neoplasm or autonomous cortisol secretion from a benign or malignant adrenal neoplasm. However, sustained or intermittent hypercortisolism may also accompany many medical disorders that stimulate physiologic/non-neoplastic activation of the HPA axis (formerly known as pseudo-Cushing's syndrome); these two entities may share indistinguishable clinical and biochemical features...
May 2017: European Journal of Endocrinology
https://www.readbyqxmd.com/read/27211794/pseudo-cushing-a-clinical-challenge
#7
REVIEW
Francesca Pecori Giraldi, Alberto G Ambrogio
The distinction between Cushing's syndrome and pseudo-Cushing is a major clinical challenge. Indeed, any endocrinologist used to dealing with Cushing's syndrome has certainly faced this dilemma more than once and is aware that there are no clear-cut solutions. Several factors contribute to this ongoing quandary, such as unbalanced epidemiology, overlap in clinical features and inherent variability in test responses. Thus, extreme care has to be taken in both excluding and confirming Cushing's syndrome in patients with mild clinical features and borderline laboratory alterations...
2016: Frontiers of Hormone Research
https://www.readbyqxmd.com/read/26976018/fitting-the-pieces-of-the-puzzle-together-a-case-report-of-the-dunnigan-type-of-familial-partial-lipodystrophy-in-the-adolescent-girl
#8
Paulina Krawiec, Beata Mełges, Elżbieta Pac-Kożuchowska, Agnieszka Mroczkowska-Juchkiewicz, Kamila Czerska
BACKGROUND: Familial partial lipodystrophy of the Dunnigan type (FPLD 2) is a rare autosomal dominant disorder caused by the mutations of the lamin A/C gene leading to the defective adipogenesis, premature death of adipocytes and lipotoxicity. FPLD 2 is characterized by a progressive loss of subcutaneous adipose tissue in the limbs and trunk, and accumulation of body fat in the face and neck with accompanying severe metabolic derangements including insulin resistance, glucose intolerance, diabetes, dyslipidemia, steatohepatitis...
March 14, 2016: BMC Pediatrics
https://www.readbyqxmd.com/read/26897783/-challenges-in-the-diagnosis-of-cushing-s-syndrome-in-the-modern-era
#9
REVIEW
Leonard Saiegh, Mohammad Sheikh-Ahmad, Maria Reut, Yousef Jubran, Carmela Shechner
Cushing's syndrome results from prolonged and excessive exposure to medically prescribed corticosteroids, or from excess endogenous cortisol secretion. When endogenous cortisol secretion is suspected, several screening tests are conducted in order to confirm or to rule out the diagnosis. In recent years, as the cut-off point of cortisol concentration on the 1 mg overnight dexamethasone suppression test was lowered, the prevalence of Cushing's syndrome has increased, and more cases of mild syndromes, with negative results on one or more screening tests, have increasingly been reported...
December 2015: Harefuah
https://www.readbyqxmd.com/read/26656734/performance-of-the-4-mg-intravenous-dexamethasone-suppression-test-in-differentiating-cushing-disease-from-pseudo-cushing-syndrome
#10
Migueline Nouvel, Muriel Rabilloud, Véronique Raverot, Fabien Subtil, Julien Vouillarmet, Charles Thivolet, Emmanuel Jouanneau, Françoise Borson-Chazot, Michel Pugeat, Gérald Raverot
CONTEXT: Discriminating Cushing disease (CD) from pseudo-Cushing syndrome (PCS) is a challenging task that may be overcome with the 4-mg intravenous (IV) dexamethasone suppression test (DST). OBJECTIVE: Assess the performance of the 4-mg IV DST in the differential diagnosis between CD and PCS in well-characterized patients. DESIGN: Retrospective comparative study of subjects seen in a tertiary care unit (November 2008 to July 2011). METHODS: Thirty-six patients with PCS and 32 patients with CD underwent 4-mg IV dexamethasone infusions from 11 am to 3 pm...
February 2016: Annales D'endocrinologie
https://www.readbyqxmd.com/read/26608494/-pitfalls-in-the-diagnosis-of-hypercortisolemia
#11
REVIEW
Adam Maciejewski, Angelika Stellmach, Katarzyna Łącka
Cushing's syndrome (CS) is relatively rare disorder affecting 2-5 per million per year, although the issue of establishing the diagnosis of CS and differential diagnosis of the disease are a significant clinical problem. CS is usually the result of excessive exogenous glucocorticoids usage (iatrogenic CS), endogenous CS can be divided into ACTH-dependent and ACTH-independent. Regardless of its etiology, the most important steps in establishing the diagnosis of CS are taking careful history and examination. The symptoms with high discriminatory value are myopathy, reddish purple striae, easy bruising and plethora...
October 2015: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
https://www.readbyqxmd.com/read/26277697/dexamethasone-suppressed-corticotropin-releasing-hormone-stimulation-test-in-morbid-obese-adults
#12
Leonard Saiegh, Dean Keren, Tova Rainis, Mohammad Sheikh-Ahmad, Maria Reut, Afif Nakhleh, Irit Wirsansky, Limor Chen-Konak, Elad Schiff, Carmela Shechner
PURPOSE: In order to differentiate between Cushing's syndrome (CS) and Pseudo-Cushing's syndrome, it is customary to use a test that is conducted by cortisol suppression with low-dose dexamethasone, followed by the administration of corticotropin releasing hormone (Dex-CRH test). In children with severe obesity, Dex-CRH test has shown a specificity of 55%. The aim of current study was to evaluate the specificity of Dex-CRH test in morbid obese adults. METHODS: The study included a total of 19 subjects with a body mass index (BMI) equal or higher than 40kg/m(2)...
May 2016: Obesity Research & Clinical Practice
https://www.readbyqxmd.com/read/24876502/adrenocortical-carcinoma-posing-as-a-pheochromocytoma-a-diagnostic-dilemma
#13
Sumita Jain, Lakshman Agarwal, Shravan Nadkarni, Atul Ameta, Ashish Goyal, Ranjan Kumar, Arjun Rao, Kamalkant Gupta
Adrenocortical carcinoma (ACC) is a malignant tumour arising from the adrenal cortex, whereas pheochromocytoma is a tumour of the adrenal medulla with occasional presence at extra-adrenal sites. Most of the adrenocortical tumours present clinically with Cushing's syndrome and signs of virilization due to over-production of the respective hormones. It is, however, rare for an adrenocortical tumour to present clinically as a pheochromocytoma. We report the case of a 45-year-old female presenting with clinical symptoms and signs of pheochromocytoma and investigations that resulted in a diagnostic dilemma...
May 12, 2014: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/24801134/hypercortisolism-in-obesity-associated-hypertension
#14
REVIEW
Amy G Varughese, Oksana Nimkevych, Gabriel I Uwaifo
Obesity is prevalent worldwide and associated with co-morbidities that result in increased cardiovascular risk. Hypertension is the most prevalent obesity comorbidity associated with increased cardiovascular risk. Obesity hypertension is a distinct subtype of essential hypertension. While endogenous Cushing's syndrome is an uncommon cause of both obesity and hypertension, the recent recognition of other hypercortisolemic states has raised the profile of hypercortisolism as an important contributor in obesity hypertension...
July 2014: Current Hypertension Reports
https://www.readbyqxmd.com/read/24642251/musculoskeletal-manifestations-of-endocrine-disorders
#15
REVIEW
Stephanie B Boswell, Dakshesh B Patel, Eric A White, Christopher J Gottsegen, Deborah M Forrester, Sulabha Masih, George R Matcuk
Endocrine disorders can lead to disturbances in numerous systems within the body, including the musculoskeletal system. Radiological evaluation of these conditions can demonstrate typical appearances of the bones and soft tissues. Knowledge of these patterns can allow the radiologist to suggest a diagnosis that may not be clinically apparent. This review will highlight the typical musculoskeletal findings of acromegaly, hypercortisolism, hyperthyroidism, hypothyroidism, hyperparathyroidism, pseudo- and pseudopseudohypoparathyroidism, and diabetes mellitus...
July 2014: Clinical Imaging
https://www.readbyqxmd.com/read/24532629/a-misleading-cause-of-pseudo-thymic-tumor-in-ectopic-cushing-s-syndrome
#16
Philippe Icard, Maxime Heyndrickx, Françoise Galateau-Salle, Yves Resnik
A 27-year-old man was referred with typical features of severe Cushing's syndrome. A bilateral adrenalectomy was performed. Three months later, a triangular nodular mediastinal enlargement, evocative of a right anterior thymic tumor, was discovered. Thymectomy was undertaken. Histological examination revealed diffuse thymic hyperplasia with negative immunostaining for adrenocorticotropic hormone. Five years later, a right endobronchial tumor corresponding to a carcinoid tumor was removed.
April 2013: Asian Cardiovascular & Thoracic Annals
https://www.readbyqxmd.com/read/24394725/differentiating-between-cushing-s-disease-and-pseudo-cushing-s-syndrome-comparison-of-four-tests
#17
R A Alwani, L W Schmit Jongbloed, F H de Jong, A J van der Lely, W W de Herder, R A Feelders
OBJECTIVE: To evaluate the diagnostic performance of four different tests in order to differentiate between Cushing's disease (CD) and pseudo-Cushing's syndrome (PCS). METHODS: In this prospective study, a total of 73 patients with clinical features of hypercortisolism and insufficient suppression of serum cortisol after 1 mg overnight dexamethasone and/or an elevated excretion of cortisol in 24-h urine samples were included. The circadian rhythm of serum cortisol levels as well as midnight serum cortisol (MserC) levels were assessed in all 73 patients...
April 2014: European Journal of Endocrinology
https://www.readbyqxmd.com/read/24282037/harmful-effects-of-functional-hypercortisolism-a-working-hypothesis
#18
REVIEW
Giacomo Tirabassi, Marco Boscaro, Giorgio Arnaldi
Functional hypercortisolism (FH) is caused by conditions able to chronically activate hypothalamic-pituitary-adrenal axis and usually occurs in cases of major depression, anorexia nervosa, bulimia nervosa, alcoholism, diabetes mellitus, simple obesity, polycystic ovary syndrome, obstructive sleep apnea syndrome, panic disorder, generalized anxiety disorder, shift work, and end-stage renal disease. Most of these states belong to pseudo-Cushing disease, a condition which is difficult to distinguish from Cushing's syndrome and characterized not only by biochemical findings but also by objective ones that can be attributed to hypercortisolism (e...
August 2014: Endocrine
https://www.readbyqxmd.com/read/24262982/adrenal-disorders-in-human-immunodeficiency-virus-hiv-infected-patients
#19
REVIEW
Justine Bons, Lucile Moreau, Hervé Lefebvre
Human Immunodeficiency Virus (HIV) infection is associated with adrenal disorders, which must not be underestimated. Adrenal morphologic changes are primarily related to opportunistic infections, mostly by cytomegalovirus and mycobacteria, and malignant tumours such as non-Hodgkin's lymphoma and Kaposi's sarcoma. The most frequent biological alteration reported to date is the increases in cortisol concentrations which results from a decrease in cortisol metabolism and hyperactivity of the hypothalamo-pituitary-adrenal axis commonly referred to as pseudo-Cushing's syndrome...
December 2013: Annales D'endocrinologie
https://www.readbyqxmd.com/read/24090942/liver-abnormalities-and-endocrine-diseases
#20
REVIEW
Patrizia Burra
The liver and its pleotropic functions play a fundamental role in regulating metabolism, and is also an inevitable target of multiple metabolic disorders. The numerous and constant relationships and feedback mechanisms between the liver and all endocrine organs is reflected by the fact that an alteration of one oftentimes results in the malfunction of the other. Hypo- and hyperthyroidism are frequently associated with hepatic alterations, and thyroid diseases must be excluded in transaminase elevation of unknown cause...
August 2013: Best Practice & Research. Clinical Gastroenterology
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