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    40 results match your criteria Pseudo-Cushing Syndrome

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    DIAGNOSIS OF ENDOCRINE DISEASE: Differentiation of Pathologic/Neoplastic Hypercortisolism (Cushing Syndrome) from Physiologic/Non-neoplastic Hypercortisolism (formerly known as Pseudo-Cushing Syndrome).
    Eur J Endocrinol 2017 Feb 8. Epub 2017 Feb 8.
    H Raff, Endocrine Research Lab, Aurora St. Luke's Medical Center, Milwaukee, 53215, United States
    Endogenous hypercortisolism (Cushing 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 syndrome); these two entities may share indistinguishable clinical and biochemical features. A thorough history and physical examination is often the best (and sometimes only) way to exclude pathologic/neoplastic hypercortisolism. Read More

    Pseudo-Cushing - A Clinical Challenge?
    Front Horm Res 2016 17;46:1-14. Epub 2016 May 17.
    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. Read More

    Performance of the 4-mg intravenous dexamethasone suppression test in differentiating Cushing disease from pseudo-Cushing syndrome.
    Ann Endocrinol (Paris) 2016 Feb 3;77(1):30-6. Epub 2015 Dec 3.
    Fédération d'endocrinologie, groupement hospitalier Est, Hospices Civils de Lyon, 69500 Bron, France; Service de biostatistique, Hospices Civils de Lyon, 69003 Lyon, France; Université de Lyon, 69000 Lyon, France; Inserm, U1028, 69008 Lyon, France. Electronic address:
    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). Read More

    Harmful effects of functional hypercortisolism: a working hypothesis.
    Endocrine 2014 Aug 27;46(3):370-86. Epub 2013 Nov 27.
    Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy.
    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.g. Read More

    Liver abnormalities and endocrine diseases.
    Best Pract Res Clin Gastroenterol 2013 Aug;27(4):553-63
    Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Via Giustiniani 2, 35128 PD Padua, Italy. Electronic address:
    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. Read More

    Reassessing the reliability of the salivary cortisol assay for the diagnosis of Cushing syndrome.
    J Int Med Res 2013 Oct 24;41(5):1387-94. Epub 2013 Sep 24.
    Department of Endocrinology, Chinese PLA General Hospital, Beijing, China.
    Objective: The cortisol concentration in saliva is 10-fold lower than total serum cortisol and accurately reflects the serum concentration, both levels being lowest around midnight. The salivary cortisol assay measures free cortisol and is unaffected by confounding factors. This study analysed published data on the sensitivity and specificity of salivary cortisol levels in the diagnosis of Cushing syndrome. Read More

    Alcohol-induced Cushing syndrome. Hypercortisolism caused by alcohol abuse.
    Neth J Med 2011 Jul-Aug;69(7):318-23
    Department of Internal Medicine and Endocrinology, Leiden University Medical Center, Leiden, the Netherlands.
    Background: Cushing's syndrome (CS), a rare syndrome caused by overexposure to glucocorticoids, is difficult to diagnose. The underlying causes of CS include pituitary and ectopic adrenocorticotropic hormone (ACTH) producing tumours and adrenal adenomas or hyperplasia. Alcoholism, however, can cause similar symptoms, giving rise to a so-called pseudo-Cushing state, which aggravates the differential diagnostic dilemmas of CS. Read More

    Use of the desmopressin test in the differential diagnosis of pseudo-Cushing state from Cushing's disease.
    J Clin Endocrinol Metab 2010 Mar 15;95(3):1115-22. Epub 2010 Jan 15.
    Clinica di Endocrinologia, Ospedali Riuniti, Via Conca 71, 60020 Ancona, Italy.
    Context: The desmopressin (DDAVP) test has been proposed to discriminate Cushing's disease (CD) from pseudo-Cushing states (PC); however, current information on its value is scarce and contradictory.

    Objective: The aim of the study was to assess the ability of the DDAVP test in distinguishing between these conditions, with emphasis on subjects with mild hypercortisolism.

    Design And Setting: We conducted a retrospective/prospective study at the Division of Endocrinology, Polytechnic University of Marche, Ancona, Italy. Read More

    In what clinical settings should Cushing's syndrome be suspected?
    Medicina (B Aires) 2009 ;69(6):674-80
    División Endocrinología, Hospital de Clínicas, Facultad de Medicina, Universidad de Buenos Aires, Argentina.
    Despite its low frequency, endogenous Cushing's syndrome is not an exceptional clinical entity. A growing number of cases are currently derived to specialized centers suggesting an increasing knowledge of the clinical features of hypercortisolism by specialists of diverse branches of clinical medicine. Clinical signs derive from an exaggeration of the physiological actions of cortisol inducing protein breakdown, hyperglycemia, fat mobilization, dyslipidemia, hydrosaline retention, immunosuppression and increased susceptibility to infection. Read More

    Human corticotropin releasing hormone test performance in the differential diagnosis between Cushing's disease and pseudo-Cushing state is enhanced by combined ACTH and cortisol analysis.
    Eur J Endocrinol 2009 Jun 25;160(6):891-8. Epub 2009 Mar 25.
    Division of Endocrinology, Polytechnic University of Marche, 60100 Ancona, Italy Social Gerontology Unit, Research Department, INRCA (Italian National Institute on Ageing), 60100 Ancona, Italy.
    Objective: Corticotropin releasing hormone (CRH) test does not reliably distinguish Cushing's disease (CD) from normality or pseudo-Cushing state (PC). We assessed whether this could be achieved with a novel approach while preserving the ability of the test to distinguish CD from ectopic ACTH syndrome (EAS). Design Retrospective/prospective study. Read More

    Severe obesity confounds the interpretation of low-dose dexamethasone test combined with the administration of ovine corticotrophin-releasing hormone in childhood Cushing syndrome.
    J Clin Endocrinol Metab 2008 Nov 26;93(11):4323-30. Epub 2008 Aug 26.
    Section on Endocrinology and Genetics, Program in Developmental Endocrinology and Genetics, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA.
    Context: Suppression of cortisol secretion with a low-dose dexamethasone (Dex) followed by the administration of ovine CRH (Dex-oCRH) is used in the evaluation of adults with a pseudo-Cushing syndrome state (PCSS) vs. Cushing syndrome (CS).

    Objective: The aim of the study was to determine the value of Dex-oCRH testing in the investigation of childhood CS. Read More

    Advantage of salivary cortisol measurements in the diagnosis of glucocorticoid related disorders.
    Clin Biochem 2008 Jun 5;41(9):688-92. Epub 2008 Feb 5.
    Clinical Chemistry Department, University Clinic of Navarra, University of Navarra, Pamplona, Spain.
    Objective: Salivary cortisol in the assessment of glucocorticoid related disorders. DESIGN-METHODS: Serum and salivary cortisol were measured in 189 patients (22 Cushing's syndrome, 67 pseudo-Cushing, 11 Addison's disease, 89 controls) at 8:00 and 24:00 h.

    Results: Serum and salivary cortisol correlated in the whole study population (r=0. Read More

    [Pseudo-Cushing states].
    Arq Bras Endocrinol Metabol 2007 Nov;51(8):1303-13
    Unidade de Neuroendocrinologia da Disciplina de Endocrinologia, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP.
    Pseudo-Cushing syndromes are a heterogeneous group of disorders, including alcoholism, anorexia nervosa, visceral obesity, and depression, which share many of the clinical and biochemical features of Cushing's syndrome. The mechanisms responsible for the genesis of pseudo-Cushing's syndrome are poorly understood. It has been suggested that hypercortisolism of pseudo-Cushing syndrome may be the result of increased hypothalamic corticotrophin-releasing hormone (CRH) secretion in the context of a hypothalamic-pituitary-adrenal axis that is otherwise normally constituted. Read More

    Screening and diagnosis of Cushing's syndrome.
    Arq Bras Endocrinol Metabol 2007 Nov;51(8):1191-8
    Division of Endocrinology & Metabolism, Department of Internal Medicine, University of São Paulo, Ribeirão Preto, SP.
    Cushing's syndrome (CS) results from sustained pathologic hypercortisolism. The clinical features are variable and the most specific features for CS include abnormal fat distribution, particularly in the supraclavicular and temporal fossae, proximal muscle weakness, wide purple striae, and decreased linear growth with continued weight gain in a child. Clinical presentation of CS can be florid and in this case the diagnosis is usually straightforward. Read More

    Diagnostic approach to Cushing disease.
    Neurosurg Focus 2007 ;23(3):E1
    Department of Neurological Surgery, The Feinberg School of Medicine and McGaw Medical Center, Northwestern University, Chicago, Illinois, USA.
    In Cushing disease, a pituitary corticotroph neoplasm causes secondary adrenal hypercortisolism. This condition has known morbidity and mortality, underscoring the need for an efficient and accurate diagnostic approach. An 11 p. Read More

    Reevaluation of the combined dexamethasone suppression-corticotropin-releasing hormone test for differentiation of mild cushing's disease from pseudo-Cushing's syndrome.
    J Clin Endocrinol Metab 2007 Nov 17;92(11):4290-3. Epub 2007 Jul 17.
    Department of Endocrinology, University Hospital of Bordeaux, 33600 Pessac, France.
    Context: The diagnostic accuracy of the combined dexamethasone suppression test (DST)-CRH test for the differential diagnosis between Cushing's disease (CD) and pseudo-Cushing syndrome (PCS) has recently been debated.

    Objective: Our objective was to reevaluate the performance of the DST-CRH test to differentiate CD from PCS and compare it with that of midnight plasma cortisol measurement.

    Setting: The study took place at three specialized tertiary care university hospitals. Read More

    [Hormonal axes in obesity: cause or effect?].
    Arq Bras Endocrinol Metabol 2007 Feb;51(1):34-41
    Grupo de Obesidade e Síndrome Metabólica do Serviço de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo.
    Several endocrine changes have been described in the obesity state. The corticotropic axis is hyperresponsive and there is enhancement of hormonal clearance, but cortisol levels are within the normal range. It is important to characterize a pseudo-Cushing in obesity. Read More

    Clinical review: Identifying children at risk for polycystic ovary syndrome.
    J Clin Endocrinol Metab 2007 Mar 19;92(3):787-96. Epub 2006 Dec 19.
    The University of Chicago Pritzker School of Medicine, Department of Pediatrics, Chicago, Illinois 60637, USA.
    Context: Polycystic ovary syndrome (PCOS) appears to arise as a complex trait with contributions from both heritable and nonheritable factors. Polygenic influences appear to account for about 70% of the variance in pathogenesis. In view of this evidence for congenital contributions to the syndrome, childhood manifestations may be expected. Read More

    [Factitious Cushing syndrome: two case reports].
    Rev Med Interne 2005 Dec 24;26(12):973-6. Epub 2005 Aug 24.
    Service d'endocrinologie-diabétologie du Professeur L.-Chaieb, CHU Farhat-Hached, Sousse, Tunisie.
    Introduction: Search of corticosteroid use is an important precaution before any exploration of hypercorticism. Nevertheless, this use may be factitious leading to serious misdiagnosis and pitfalls.

    Exegesis: We report two cases of 29 and 60 years old male patients, referred for hypercorticism with patent features including metabolic and trophical signs. Read More

    Midnight salivary cortisol versus urinary free and midnight serum cortisol as screening tests for Cushing's syndrome.
    J Clin Endocrinol Metab 2003 Sep;88(9):4153-7
    Department of Endocrinology, University of Milan, Istituto Scientifico Ospedale San Luca, 20149 Milan, Italy.
    The diagnosis of Cushing's syndrome (CS) is often a challenge. Recently, the determination of late night salivary cortisol levels has been reported to be a sensitive and convenient screening test for CS. However, no studies have included a comparison with other screening tests in a setting more closely resembling clinical practice, i. Read More

    Pseudo-Cushing syndrome caused by fenofibrate interference with urinary cortisol assayed by high-performance liquid chromatography.
    J Clin Endocrinol Metab 2003 Aug;88(8):3521-4
    Department of Medicine, University of Utah, Salt Lake City, Utah 84132, USA.
    Urinary free cortisol (UFC) excretion over 24 h reflects the production rate of cortisol and is used commonly in the diagnosis of Cushing syndrome. We report on two patients evaluated for Cushing syndrome who had elevated UFC when analyzed by HPLC but normal values for the analysis performed by RIA and HPLC-mass spectrometry/mass spectrometry (HPLC-MS/MS). Other laboratory testing was inconsistent with the diagnosis of Cushing syndrome and raised doubts about the diagnosis. Read More

    Circadian variation in Cushing's disease and pseudo-Cushing states by analysis of F and ACTH pulsatility.
    J Endocrinol Invest 2002 Oct;25(9):791-9
    Department of Medicine, University of Chicago, IL, USA.
    Distinguishing pituitary-dependent Cushing's disease from pseudo-Cushing's states can present a diagnostic challenge. Although many studies potentially discriminate between the 2, only the dexamethasone-suppressed corticotropin-releasing hormone (CRF) stimulation test at 15 minutes is 100% sensitive or specific. We measured baseline profiles of F and ACTH in 31 Cushing's disease patients, 11 with pseudo-Cushing's and 17 controls. Read More

    Diagnostic tests for Cushing's syndrome.
    Ann N Y Acad Sci 2002 Sep;970:112-8
    Pediatric and Reproductive Endocrinology Branch, National Institute of Child Health and Human Development/NIH, Building 10, Room 9D42, 10 Center Drive MSC 1583, Bethesda, MD 20892, USA.
    The diagnosis of Cushing's syndrome rests on the demonstration of clinical features and biochemical abnormalities that reflect hypercortisolism. If a patient presents with typical clinical features such as weight gain with truncal obesity and supraclavicular fat deposition, wide purple striae, and proximal muscle weakness, the diagnosis is clear-cut and is nearly always substantiated by a 24-hour urine free cortisol excretion value more than four times the normal level. However, many patients present with signs and symptoms that are common in the general population, such as hypertension, generalized weight gain, reproductive abnormalities, and depression. Read More

    Cushing's disease: a surgical view.
    J Neurooncol 2001 Sep;54(2):151-66
    Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Germany.
    The management of adrenocorticotropic hormone (ACTH)-dependent Cushing's disease implies difficulties in the differential diagnosis, in the detection of minute pituitary adenomas, as well as in the radical removal of invasive adenomas. Magnetic resonance imaging (MRI) is unspecific and often negative in minute adenomas of three or less millimeters diameter. The trias of detectable ACTH, suppression of cortisol in the high-dose dexamethasone test, and stimulation in the corticotropin-releasing-hormone (CRH)-test has a high accuracy to prove pituitary dependency. Read More

    Epidemiology and follow-up of Cushing's disease.
    Ann Endocrinol (Paris) 2001 Apr;62(2):168-72
    Chair of Endocrinology, University of Milan Istituto Scientifico Ospedale San Luca IRCCS, Istituto Auxologico Italiano Milan, Italy.
    Little is known on the epidemiology of Cushing's disease (CD) as relevant data on such a rare disease can only be obtained from large-scale studies. We addressed this topic analyzing the data obtained in the Italian multicenter study which comprised nearly 300 patients with CD. The number of newly diagnosed patients with CD increased markedly in the second decade of the study (from 7. Read More

    [Pseudo-Cushing syndrome. Physiopathologic aspects and differential diagnosis].
    Minerva Endocrinol 2000 Jun;25(2):47-54
    Dipartimento di Medicina Interna e Gastroenterologia, Policlinico S. Orsola-Malpighi, Bologna.
    Pseudo-Cushing Syndromes (PCS) are a heterogeneous group of disorders, including alcoholism and depression, that share many of the clinical and biochemical features of Cushing's Syndrome (CS). It has been suggested that hypercortisolism of PCS may be the result of increased hypothalamic corticotropin-releasing hormone secretion in the context of a hypothalamic-pituitary-adrenal axis that is otherwise normally constituted. The substantial overlap in clinical features and daily urinary free cortisol levels between several patients with CS and those with PCS can make the differential diagnosis difficult. Read More

    The desmopressin test in the differential diagnosis between Cushing's disease and pseudo-Cushing states.
    J Clin Endocrinol Metab 2000 Oct;85(10):3569-74
    University of Milan, Istituto Scientifico Ospedale San Luca, Italy.
    Differentiating Cushing's disease (CD) from pseudo-Cushing (PC) states may still be difficult in current practice. Because desmopressin (1-deamino-8D-arginine vasopressin, DDAVP), a vasopressin analogue, stimulates ACTH release in patients with CD but not in the majority of normal, obese, and depressed subjects, we investigated its ability to discriminate CD from PC states. One hundred seventy-three subjects (76 with active CD, 30 with PC, 36 with simple obesity, and 31 healthy volunteers) were tested with an iv bolus of 10 microg DDAVP. Read More

    The role of stress and the hypothalamic-pituitary-adrenal axis in the pathogenesis of the metabolic syndrome: neuro-endocrine and target tissue-related causes.
    Int J Obes Relat Metab Disord 2000 Jun;24 Suppl 2:S50-5
    Pediatric Endocrinology Section, PREB, NICHD, National Institutes of Health, Bethesda, MD 20892, USA.
    The stress system coordinates the adaptive response of the organism to real or perceived stressors. The main components of the stress system are the corticotropin-releasing hormone (CRH) and locus ceruleus-norepinephrine/ autonomic (LC/NE) systems and their peripheral effectors, the hypothalamic-pituitary-adrenal (HPA) axis, and the limbs of the autonomic system. Activation of the stress system leads to behavioral and peripheral changes that improve the ability of the organism to adjust homeostasis and increase its chances for survival. Read More

    Plasma levels of corticotropin-releasing hormone in the inferior petrosal sinuses of healthy volunteers, patients with Cushing's syndrome, and patients with pseudo-Cushing states.
    J Clin Endocrinol Metab 1998 May;83(5):1485-8
    Office of the Director, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland 20892, USA.
    The objective of this study was to determine whether measurements of human CRH in the inferior petrosal sinuses could distinguish patients with Cushing's syndrome from those with pseudo-Cushing states or normal physiology. Twenty-five patients with Cushing's disease, 17 patients with the syndrome of ectopic ACTH, 7 patients with Cushing's syndrome of adrenal origin, 6 patients with pseudo-Cushing states, and 11 volunteers believed to have normal hypothalamic-pituitary-adrenal axes were studied. Basal plasma human CRH and ACTH were measured at two time points in the petrosal sinuses and in a peripheral vein. Read More

    A single midnight serum cortisol measurement distinguishes Cushing's syndrome from pseudo-Cushing states.
    J Clin Endocrinol Metab 1998 Apr;83(4):1163-7
    Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA.
    Cushing's syndrome (CS) may be difficult to distinguish from pseudo-Cushing states (PCS) based on physical findings or urinary glucocorticoid excretion. As the lack of diurnal variation in serum cortisol is characteristic of CS, we studied whether diurnal cortisol determinations could discriminate CS from PCS. Two hundred and sixty-three patients were evaluated: 240 had CS, and 23 had PCS. Read More

    The dexamethasone-suppressed corticotropin-releasing hormone stimulation test differentiates mild Cushing's disease from normal physiology.
    J Clin Endocrinol Metab 1998 Feb;83(2):348-52
    Office of the Director, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892-1862, USA.
    The dexamethasone-suppressed CRH test (Dex-CRH test) differentiates patients with Cushing's syndrome (CS) from those with pseudo-Cushing states, who have decreased ACTH responses to CRH because of negative feedback exerted by chronic hypercortisolism. Normal subjects, however, have not been studied with the Dex-CRH test, raising concern that this test might not separate patients with CS from patients with normal adrenal function. To determine whether the criterion that separates CS from pseudo-Cushing states also would differentiate patients with Cushing's disease (CD) from individuals with eucortisolism, we studied 20 healthy volunteers during low-dose (2 mg/day) dexamethasone suppression, and then during the Dex-CRH test (CRH stimulation test performed 2 h after completion of low-dose dexamethasone suppression), and contrasted their results with those of 20 patients with surgically proven mild CD [urine free cortisol (UFC) < 1000 nmol/day). Read More

    Adrenocorticotrophic hormone-dependent Cushing's syndrome.
    Cancer Treat Res 1997 ;89:25-40
    Developmental Endocrinology Branch, NIH Clinical Center, Bethesda, MD 20892, USA.
    Excess endogenous glucocorticoid production, whether ACTH dependent or ACTH independent, results in the classic clinical and biochemical picture of Cushing's syndrome. The diagnosis requires the demonstration of an increased cortisol secretion rate, best achieved by using the 24-hour UFC corrected for body surface area as an index. In mild cases, distinction from the hypercortisolism of pseudo-Cushing states may be difficult. Read More

    [The hypophyseal-adrenal axis in chronic alcoholism].
    Med Pregl 1996 ;49(9-10):349-55
    Institut medicinskih sluzbi Zavod za patologiju i histologiju, Medicinski fakultet, Novi Sad.
    In order to reveal the morphologic basis of clinically recognized pseudo Cushing syndrome in chronic alcoholism, we performed an analysis of histologic characteristics of hypothalamo-hypophyseal adrenal axis components. The experiment included Wistar rats which were given 15% ethanol solution in water for three months. By methods of classical histology, histochemistry and immunofluorescence adrenal and hypophyseal sections of experimental animals exposed to continual effects of alcohol and those from the control group were examined. Read More

    Morning plasma free cortisol: inability to distinguish patients with mild Cushing syndrome from patients with pseudo-Cushing states.
    J Endocrinol Invest 1995 Oct;18(9):696-701
    Laboratory of Developmental Neurobiology, Developmental Endocrinology Branch NICHD, NIH, Bethesda, Maryland, USA.
    Patients with Cushing syndrome have elevated 24 h urinary free cortisol excretion and loss of diurnal rhythm of plasma cortisol, however, morning total plasma cortisol concentrations are often similar to those of normal individuals. To test the hypothesis that an elevated morning plasma free cortisol could distinguish patients with Cushing syndrome from those without the disorder, we measured plasma free cortisol levels at 08:00 in 20 patients with surgically-confirmed mild Cushing syndrome, 19 patients with pseudo-Cushing states, and 9 normal volunteers. We then determined the sensitivity, specificity and diagnostic accuracy of plasma free cortisol for the diagnosis of hypercortisolism and for the diagnosis of Cushing syndrome. Read More

    Advances in the diagnosis and treatment of Cushing's syndrome.
    Baillieres Clin Endocrinol Metab 1995 Apr;9(2):315-36
    Developmental Endocrinology Branch, National Institutes of Health, Bethesda, MD 20892, USA.
    Excess endogenous glucocorticoid production, whether ACTH-dependent or ACTH-independent, results in the classic clinical and biochemical picture of Cushing's syndrome. The diagnosis requires demonstration of an increased cortisol secretion rate, best achieved using determination of urinary free cortisol as an index. In mild cases, distinction from the hypercortisolism of pseudo-Cushing states may prove difficult. Read More

    Glucocorticoid action and the clinical features of Cushing's syndrome.
    Endocrinol Metab Clin North Am 1994 Sep;23(3):487-509
    Section on Developmental Endocrinology, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
    Glucocorticoids mainly act through binding to cytosolic receptors that translocate to the nucleus after ligand binding, and dimerize to affect gene transcription in multiple fashions. The liganded receptors may interact with DNA at specific glucocorticoid responsive-elements, may physically hinder the ability of other transcription-regulating proteins to interact with their own DNA response-elements, and may form intranuclear complexes with the transcription factor c-jun, thus changing the number of c-jun/c-fos heterodimers that bind at AP-1 sites. By these, and perhaps other, mechanisms, physiologic concentrations of glucocorticoids regulate normal tissue metabolism, and supraphysiologic concentrations cause Cushing's syndrome. Read More

    The limited ability of inferior petrosal sinus sampling with corticotropin-releasing hormone to distinguish Cushing's disease from pseudo-Cushing states or normal physiology.
    J Clin Endocrinol Metab 1993 Aug;77(2):503-9
    Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892.
    To determine whether petrosal sinus sampling is useful to distinguish patients with mild or intermittent Cushing's disease from normal subjects and individuals with pseudo-Cushing states, we performed bilateral inferior petrosal sinus sampling for ACTH before and after the administration of CRH in 7 eucortisolemic volunteers, 8 hypercortisolemic patients with pseudo-Cushing states, and 40 patients with ACTH-dependent Cushing's disease whose urinary free cortisol excretion was within the range found in patients with, pseudo-Cushing states (< 1000 nmol/day; < 360 micrograms/day). The ACTH level, the ratio of the inferior petrosal sinus ACTH to the peripheral venous ACTH concentration (the IPS:P ratio), and the greater ratio of right to left or left to right petrosal sinuses (the R:L ratio) were compared in patients with and without Cushing's disease. Maximal petrosal ACTH values were significantly elevated in patients with Cushing's disease compared to patients with pseudo-Cushing states before CRH administration (P < 0. Read More

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