48 results match your criteria Pseudo-Cushing Syndrome


Human Corticotropin-Releasing Hormone Tests: 10 Years of Real-Life Experience in Pituitary and Adrenal Disease.

J Clin Endocrinol Metab 2020 11;105(11)

Endocrinology Unit, Department of Medicine-DIMED; University Hospital of Padova, Padova, Italy.

Context: The human corticotropin-releasing hormone (CRH) test (hCRHtest) is used to differentiate Cushing disease (CD) from ectopic adrenocorticotropin (ACTH) secretion (EAS), to assess autonomous cortisol secretion by the adrenal glands, and to characterize pseudo-Cushing syndrome (CS) or adrenal insufficiency (AI).

Main Outcome Measure: The main outcome measure of this study was to assess the diagnostic accuracy of the hCRHtest.

Methods: We measured ACTH and cortisol levels; collected the peak values (peakACTH and peakcortisol), and calculated the percentage increases (∆%ACTH and ∆%cortisol) after an intravenous bolus of 100 μg hCRH. Read More

View Article and Full-Text PDF
November 2020

Factors Affecting Dexamethasone Suppression Test Results.

Exp Clin Endocrinol Diabetes 2020 Oct 25;128(10):667-671. Epub 2019 Oct 25.

Department of Endocrinology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.

Dexamethasone suppression tests are basic tools in diagnostics of hypercortisolemia. Low-dose tests play major role in screening and initial assessment. High-dose tests are aimed at more elaborate diagnostics, however their clinical value is questionable. Read More

View Article and Full-Text PDF
October 2020

Glycogen storage disease presenting as Cushing syndrome.

JIMD Rep 2019 May 3;47(1):17-22. Epub 2019 Apr 3.

Division of Endocrinology, Department of Pediatrics Boston Children's Hospital, Harvard Medical School Boston Massachusetts.

Impaired growth is common in patients with glycogen storage disease (GSD), who also may have "cherubic" facies similar to the "moon" facies of Cushing syndrome (CS). An infant presented with moon facies, growth failure, and obesity. Laboratory evaluation of the hypothalamic-pituitary-adrenal (HPA) axis was consistent with CS. Read More

View Article and Full-Text PDF

The difficulties of pseudo-Cushing's syndrome (or "non-neoplastic hypercortisolism").

Authors:
Olivier Chabre

Ann Endocrinol (Paris) 2018 Jun 30;79(3):138-145. Epub 2018 Apr 30.

Service d'endocrinologie, faculté de médecine, unité mixte Inserm-CEA-UJF U1036 CEA, université Grenoble-Alpes, centre hospitalier universitaire Grenoble-Alpes, 38043 Grenoble, France. Electronic address:

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. Read More

View Article and Full-Text PDF

DIAGNOSIS OF ENDOCRINE DISEASE: The role of the desmopressin test in the diagnosis and follow-up of Cushing's syndrome.

Eur J Endocrinol 2018 May 22;178(5):R201-R214. Epub 2018 Feb 22.

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. Read More

View Article and Full-Text PDF

Hypokalemia associated with pseudo-Cushing's syndrome and magnesium deficiency induced by chronic alcohol abuse.

CEN Case Rep 2018 May 15;7(1):148-152. Epub 2018 Feb 15.

Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.

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. Read More

View Article and Full-Text PDF

Differentiation of pathologic/neoplastic hypercortisolism (Cushing syndrome) from physiologic/non-neoplastic hypercortisolism (formerly known as Pseudo-Cushing syndrome): response to Letter to the Editor.

Eur J Endocrinol 2018 03;178(3):L3

Departments of MedicineSurgery, and Physiology, Medical College of Wisconsin and Endocrine Research Laboratory, Aurora St Luke's Medical Center, Aurora Research Institute, Milwaukee, Wisconsin, USA.

View Article and Full-Text PDF

Hypercortisolemia and Depressive-like Behaviors in a Rhesus Macaque () Involved in Visual Research.

Comp Med 2017 Dec;67(6):529-536

Animal Resources Department, The Salk Institute for Biological Studies, La Jolla, California;, Email:

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. Read More

View Article and Full-Text PDF
December 2017

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

View Article and Full-Text PDF
September 2017

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

View Article and Full-Text PDF
February 2016

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

View Article and Full-Text PDF

Liver abnormalities and endocrine diseases.

Authors:
Patrizia Burra

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

View Article and Full-Text PDF

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

View Article and Full-Text PDF
October 2013

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

View Article and Full-Text PDF
February 2012

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

View Article and Full-Text PDF

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

View Article and Full-Text PDF

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

View Article and Full-Text PDF

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

View Article and Full-Text PDF
November 2008

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

View Article and Full-Text PDF

[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

View Article and Full-Text PDF
November 2007

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

View Article and Full-Text PDF
November 2007

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

View Article and Full-Text PDF
December 2007

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

View Article and Full-Text PDF
November 2007

[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

View Article and Full-Text PDF
February 2007

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

View Article and Full-Text PDF

[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

View Article and Full-Text PDF
December 2005

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

View Article and Full-Text PDF
September 2003

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

View Article and Full-Text PDF

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

View Article and Full-Text PDF
October 2002