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PubMed1986

Diagnosis and pathophysiology of Cushing's syndrome.

Cushing's syndrome is the consequence of a sustained overproduction of cortisol (hydrocortisone) by the adrenal cortex. This may be due to excessive secretion of cortisol by functioning adrenocortical tumors or to "nontumorous" adrenocortical hyperfunction. The latter may be a result of stimulation of the adrenal cortex by increased release of corticotropin (ACTH) from a small pituitary tumor or from nonpituitary nonadrenal tumor. Carcinoids or carcinomas of the lung or pancreas, and even pheochromocytomas have caused the syndrome of ectopic ACTH production. The problems involved in the diagnosis of Cushing's syndrome are establishing its presence and determining the underlying cause. Treatment is then dependent upon the underlying pathogenetic lesion.

Adenoma↗
PubMed1990

[Iatrogenic Cushing syndrome in infants. Report of a case with dwarfism].

We report a case of iatrogenic Cushing syndrome with dwarfism (-6 SD) in an eight-month-old infant. The respective role of exposure to corticosteroids in utero (the mother took 30 mg prednisolone per day throughout pregnancy) and postnatally (oral prednisolone, prednisolone in breast milk, and betamethasone cream) is discussed. Two other features are pointed out, i.e. presence of a food allergy and favorable outcome under hydrocortisone therapy.

Adrenal Cortex Hormones↗
PubMed1989

[Rare variants and unusual course of Cushing's syndrome].

Cushing's syndrome is a rarely observed disease with a poor prognosis when not treated appropriately. Knowledge of clinical features of the different forms of the disease together with a specific and subtle method of cortisol detection is indispensable for an early out-patient diagnostic program. In this study the characteristic features of the rare benign and malignant forms of Cushing's syndrome are presented in typical case-reports. As it has been proven in clinical experience, the necessary diagnostic measures for clarification of the syndrome consists of only few methods reliable concerning their diagnostic validity. The success of any curative treatment of the benign forms or any palliative measure of the malignant forms essentially depends on early diagnosis and differentiation of the various appearances of Cushing's disease.

Adrenal Gland Diseases↗
PubMed2003

Dynamic tests in the diagnosis and differential diagnosis of Cushing's syndrome.

Cushing's syndrome is an uncommon disorder, but one that often presents diagnostic challenges to the managing physician. Since the 1960's, dynamic tests have been a mainstay of the investigation of this disorder, both to make the diagnosis and then to identify the cause. It is in this latter role that these tests provide the greatest results, particularly in cases of ACTH-dependent disease, where defining the source accurately allows targeted surgery to the pituitary or ectopic lesions. It can, however, be a confusing area, as multiple protocols, and therefore cut-off criteria, often exist for each test, and some tests are now largely redundant. Therefore, in this article we discuss the physiological basis behind each dynamic test, review the different protocols and criteria that have been utilized, and assess how they perform. It will become clear that no single dynamic test used in this condition is 100% reliable for either the diagnosis or differential diagnosis, but the combination of test results, together with the knowledge of an endocrinologist experienced in such cases, provides the best means of correctly assessing patients with Cushing's syndrome.

Adrenal Cortex Function Tests↗
PubMed2002

The medical management of Cushing's syndrome.

Cushing's syndrome results from prolonged exposure to excessive circulating glucocorticosteroids, and is associated with significant morbidity and mortality. While the treatment of choice in most patients is surgical, the metabolic consequences of the syndrome, including increased tissue fragility, poor wound healing, hypertension, and diabetes mellitus, increase the risks of such surgery. The hypercortisolemia and its sequelae can be efficiently reversed using medical therapy, either as a temporary measure prior to definitive treatment, or longer term in more difficult cases. Drug treatment has been targeted at the hypothalamic/pituitary level, the adrenal glands, and also at the glucocorticoid receptor level. In this review we discuss the pharmacotherapeutic agents that have been used in Cushing's syndrome, and their efficacy, the monitoring of treatment, and potential therapies that may prove useful in the future in this complex endocrinological disorder.

Adrenal Glands↗
PubMed2004

Exacerbations of Graves' disease after unilateral adrenalectomy for Cushing's syndrome.

Cushing's syndrome is characterized by endogenously increased production of glucocorticoids. The activity of immune system is regulated mainly by two systems in the body. Glucocorticoids and NF-kappaB counteract the effects of each other on the immune system. It has been reported that immune response is exaggerated after the amelioration of Cushing's syndrome. We report a rare case of exacerbation of Graves' disease after unilateral adrenalectomy for Cusing's syndrome. A 50-yr-obese woman with hypertension, dyslipidemia, impaired glucose tolerance and insulin resistance wasadmitted to outpatients clinic of endocrinology. The results of evaluation of glucocorticoids metabolism and adrenal magnetic resonance imaging revealed the Cusing's syndrome. We also assessed thyroid function tests because of the diagnosis of goiter and thyroid hormone replacement in her medical history, and the presence of exophthalmia and tachycardia in examination. Althoug TSH level was detected at the lower border of normal range, free T4 and free T3 were in normal range and autoantibody of thyroidal peroxidase and thyroglobulin was higer than normal reference range. An operation was performed and a mass was removed from her left adrenal gland. The pathologic examination confirmed adrenal adenoma. She was re-admitted to the outpatient clinic 9 months after with complaints of palpitation, malaise and weight loss. Tests carried out to determine the thyroid function revealed Graves' disease. We prescribed propylthiouracil and beta-blocker treatment.

Adrenalectomy↗
PubMed1981

[Adenylate cyclase activity and cyclic nucleotide content in human adrenal tumors under Icenko-Cushing syndrome].

The adenylate cyclase activity and cyclic nucleotide content in excised human adrenal tumours (Icenko-Cushing syndrome) were determined. The experimental data were compared to those obtained for hyperplastic adrenals. All adrenal tumours under study revealed a decreased cAMP level, an increased cGMP level and a resulting decrease of the cAMP/cGMP ratio. In malignant adrenal tumours the adenylate cyclase activity was sharply increased in comparison with that in hyperplastic adrenals. In the majority of malignant tumours the adenylate cyclase response to ACTH was either altogether absent or sharply decreased. In benign adrenal tumours the basal activity of the enzyme was unchanged and the enzyme response to ACTH was essentially normal. The decrease of adenylate cyclase response to ACTH in malignant tumours is apparently not due to the impaired catalytic activity of the enzyme, since its response to stimulation by sodium fluoride remains unaffected. In some tumours (one malignant and two benign ones) a non-specific stimulation of adenylate cyclase by hormones, which are not natural activators of the enzyme was observed. It was assumed that these changes are due to the damage of hormonal receptors in adrenal tumours.

Adenylyl Cyclases↗
PubMed1994

[Analysis of blood from the inferior sinus petrosus in patients with Cushing syndrome and acromegaly].

Bilateral catheterization of sinus petrosus inferior was performed in ten patients with Cushing's syndrome and five patients with acromegaly. This was done in order to secure the diagnosis (Cushing's syndrome) and localize an adenoma (Cushing's syndrome and acromegaly). Blood from sinus petrosus inferior on both sides and from the peripheral vein was analyzed for concentration of ACTH or growth hormone after injection of ACTH-releasing hormone and growth hormone-releasing hormone respectively. The quotient between the ACTH concentration in blood from sinus petrosus and peripheral blood determines the diagnosis in Cushing's syndrome and the quotient between the concentration of ACTH or growth hormone between right and left sinus petrosus determines localization of the pituitary adenoma. Correct diagnosis and localization of ACTH-producing pituitary adenoma was found in eight of ten patients with Cushing's syndrome. One result was doubtful and one was wrong. In four patients with Cushing's disease (ACTH-producing adenoma) magnetic tomography (MT) was negative, but catheterization showed the presence of adenoma. In acromegalic patients, correct localization of the adenoma was determined in two out of five patients. In the other three patients, anatomical difficulties prevented satisfactory interpretation.

Acromegaly↗
PubMedDate not supplied

[Lipolytic and lipoprotein lipase activity of subcutaneous and visceral adipose tissue in Cushing's syndrome].

Cushing's syndrome has been recently compared to visceral-type obesity, since it is characterised by the accumulation of adipose tissue at a deep abdominal site, to the detriment of the subcutaneous adipose panniculus, and is associated with insulin-resistance and hyperlipemia. The aim of the present study was to evaluate the influence of glucocorticoid hormones on lipolytic activity (index of FFA mobilisation) and on lipoproteinlipase (LPL) activity (an index of the accumulation of triglycerides) in subcutaneous and perirenal adipose tissue in order to clarify the mechanisms involved in this type of accumulation in Cushing's syndrome. Five patients (4 F and 1 M) were included in the study, mean age 27.8 +/- 3.7 years and BMI 21.3 +/- 1.2 kg/m2; patients were hospitalised in the 2nd Surgical Clinic at the University of Padua and underwent surgery for secondary corticosurrenal hyperplasia with ACTH secreting hypophysial adenoma. Lipolytic activity in subcutaneous adipose tissue in these patients was significantly lower (p less than 0.05) than in control subjects, in particular after noradrenalin stimulation (p less than 0.01). No significant difference was observed when lipolytic activity in subcutaneous adipose tissue was compared to that one in perirenal tissue. LPL activity in subcutaneous adipose tissue did not reveal statistically significant differences compared to control subjects, although values were lower. A further decrease in LPL activity, which was not however significant, was observed in perirenal tissue in comparison to subcutaneous tissues in the same patients. The mean weight of adipocytes (ug) was slightly lower in subcutaneous adipose tissue compared to control subjects and even lower in perineal tissue in comparison to the subcutis in the same patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗
PubMed2006

Cushing syndrome with secondary adrenal insufficiency from concomitant therapy with ritonavir and fluticasone.

We present 2 cases of Cushing syndrome with secondary adrenal insufficiency from concomitant use of ritonavir and inhaled corticosteroids in children with human immunodeficiency virus infection. These cases highlight the need for special consideration when treatment with an inhaled/intranasal corticosteroid is indicated in children receiving antiretroviral therapy.

Administration, Inhalation↗
PubMedDate not supplied

Clinical and genetic analysis of primary bilateral adrenal diseases (micro- and macronodular disease) leading to Cushing syndrome.

Primary bilateral adrenocortical diseases are rare entities that have recently been appreciated as potential causes of Cushing syndrome. They include (i) primary pigmented adrenocortical disease (PPNAD), also known as "micronodular adrenal disease", which is a genetic disorder that is often associated with Carney complex, and (ii) massive macronodular adrenocortical disease (MMAD), a rare disorder of unknown etiology that affects older adults. Carney complex is a multiple endocrine neoplasia (MEN) syndrome that affects not only the adrenal cortex, but also the pituitary, thyroid, and gonads. It is associated with pigmentation abnormalities as well as myxomas and other mesenchymal and neural crest neoplasms. The inheritance of the complex is autosomal dominant, and genetic mapping has shown that at least two loci are involved in its pathogenesis. MMAD appears to be an isolated finding in most cases, and a genetic defect has not yet been defined. Ectopic expression of hormone receptors has been implicated in several cases of MMAD, but an underlying deficit has not been detected. Bilateral adrenocortical hyperplasia has also been described in McCune-Albright syndrome and MEN type-1, but this finding is not always associated with hypercortisolism. The genetic defects for these diseases are known, but their role in adrenal cortex pathophysiology has not been fully elucidated. Identification of the molecular defects responsible for bilateral adrenocortical disorders is expected to shed light on many aspects of early adrenal gland differentiation and tumorigenesis.

Adrenal Cortex Diseases↗
PubMed1988

Long acting somatostatin treatment of paraneoplastic Cushing's syndrome in a case of Zollinger-Ellison syndrome.

Cushing's syndrome, caused by ectopic ACTH production during Zollinger-Ellison syndrome, raises difficult therapeutic problems. We report a case of clinical and biological efficacy of long acting somatostatin (SMS) in this condition. In a short term study with 200 micrograms SMS bid, symptoms of hypercorticism disappeared while cortisol and ACTH serum concentrations fell below the normal values. Longterm treatment was instituted with 50 micrograms SMS bid. Excellent clinical efficacy as well as normal cortisol and ACTH serum concentrations were maintained during the nine month follow up. Lipotrophic hormone (LPH) serum concentration remained raised. No decrease in size of hepatic metastases was observed. Long acting somatostatin analogues may be useful in endocrine paraneoplastic syndromes.

ACTH Syndrome, Ectopic↗