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pseudo cushings

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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Daisuke Tamada, Michio Otsuki, Susumu Kashine, Ayumu Hirata, Toshiharu Onodera, Tetsuhiro Kitamura, Iichiro Shimomura
Activation of the hypothalamic-pituitary-adrenal axis has been reported in some patients with the obstructive sleep apnea syndrome (OSAS). In current study, we investigated whether OSAS affect the screening test for subclinical Cushing's disease using 0.5 mg overnight dexamethasone suppression test (DST) in Japanese obese diabetic patients with OSAS. Among Japanese obese patients with type 2 diabetes mellitus who had been hospitalized in our department, we selected 20 patients with moderate to severe untreated OSAS (apnea-hypoxia index, AHI, of ≥15 events/hour)...
2013: Endocrine Journal
Łukasz Żukowski, Janusz Myśliwiec, Maria Górska
INTRODUCTION: The aim of this study was the comparison of 24h urine free cortisol (UFC), serum cortisol at 11pm (SCM) and late-nightsalivary cortisol (LSC) in patients suspected for hypercortisolism, and an assessment of the usefulness of these measurements in diagnosingovert Cushing's (OCS) syndrome, pseudo Cushing's state (PCS) and subclinical Cushing's syndrome (SCS). MATERIAL AND METHODS: The study group consisted of 82 patients, of whom four patients had SCS, three OCS and eight PCS...
2013: Endokrynologia Polska
J Lindholm
The dexamethasone (DXM) test has been widely used for diagnosing Cushing's disease (CD). The purpose of this paper is to review its diagnostic merit based on calculation of data extracted from earlier publications. Studies presenting individual values for patients with CD and normal subjects were identified through PubMed searches and references in pertinent studies. Calculation of the retrieved data demonstrated huge variation in the relative suppressibility, negative suppression being common. Furthermore, in almost each study retrieved, the pre and post DXM values were closely correlated...
August 2014: Pituitary
M S Sarwar, M S Islam, S M E Al Baker, A Hasnat
Resistant hypertension (RH) is defined as failure to achieve goal blood pressure while receiving a 3 drug regimen at optimal doses that includes a diuretic. The exact prevalence of resistant hypertension is unknown which may vary from 5% to 50%. Patient or clinician-related factors contributing to resistant hypertension include patient's non-adherence to antihypertensive therapy, White-coat effect and pseudo-hypertension and life style factors (Obesity, alcohol, smoking, dietary sodium etc). Several drugs may induce pre-existing hypertension where non-steroidal anti-inflammatory drugs are usually the most common due to their frequent use; whereas oral contraceptives, sympathomimetics (decongestants, anorectics), adrenal steroids and antineoplastic drugs targeting the vascular endothelial growth factor (VEGF) pathway has a good deal of contribution to resistant hypertension...
May 2013: Drug Research
V P Singh, Manjeet Singh, Mridul Malhotra, Ashok Kumar, A K Agarwal
There are at least 5% of all hypertensive patients whose blood pressure (BP) remains elevated despite adequate treatment. In these cases, the clinician is forced to search for a secondary cause of the chronic BP elevation. Certain environmental factors are known to induce resistant-hypertension. Additionally, there may be pseudo-resistance occurring or the patient may be suffering from a secondary form of hypertension such as renovascular or endocrinological hypertension (phaeochromocytoma, Cushing's syndrome, etc...
March 2012: Indian Heart Journal
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