scholarly journals Indication to dynamic and invasive testing in Cushing’s disease according to different neuroradiological findings

2021 ◽  
Author(s):  
E. Ferrante ◽  
M. Barbot ◽  
A. L. Serban ◽  
F. Ceccato ◽  
G. Carosi ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Cushing’S Syndrome ◽  
Cushing’S Disease ◽  
Surgical Outcome ◽  
Positive Response ◽  
Cushing's Syndrome ◽  
Cushing's Disease ◽  
Lesion Group ◽  
Group A ◽  
Noninvasive Tests

Abstract Purpose Dynamic testing represents the mainstay in the differential diagnosis of ACTH-dependent Cushing’s syndrome. However, in case of undetectable or detectable lesion < 6 mm on MRI, bilateral inferior petrosal sinus sampling (BIPSS) is suggested by current guidelines. Aim of this study was to analyze the performance of CRH, desmopressin and high-dose dexamethasone suppression test (HDDST) in the differential diagnosis of ACTH-dependent Cushing’s syndrome as well as the impact of invasive and noninvasive tests on surgical outcome in patients affected by Cushing’s disease (CD). Methods Retrospective analysis on 148 patients with CD and 26 patients with ectopic ACTH syndrome. Results Among CD patients, negative MRI/lesion < 6 mm was detected in 97 patients (Group A); 29 had a 6–10 mm lesion (Group B) and 22 a macroadenoma (Group C). A positive response to CRH test, HDSST and desmopressin test was recorded in 89.4%, 91·4% and 70.1% of cases, respectively. Concordant positive response to both CRH/HDDST and CRH/desmopressin tests showed a positive predictive value of 100% for the diagnosis of CD. Among Group A patients with concordant CRH test and HDDST, no difference in surgical outcome was found between patients who performed BIPSS and those who did not (66.6% vs 70.4%, p = 0.78). Conclusions CRH, desmopressin test and HDDST have high accuracy in the differential diagnosis of ACTH-dependent CS. In patients with microadenoma < 6 mm or non-visible lesion, a concordant positive response to noninvasive tests seems sufficient to diagnose CD, irrespective of MRI finding. In these patients, BIPSS should be reserved to discordant tests.

Urinary excretion rates of 15 free steroids: potential utility in differential diagnosis of Cushing's syndrome.

1986 ◽  
Vol 32 (1) ◽  
pp. 93-96 ◽  
Author(s):  
M Schöneshöfer ◽  
B Weber ◽  
W Oelkers ◽  
K Nahoul ◽  
F Mantero
Keyword(s):  
Differential Diagnosis ◽  
Urinary Excretion ◽  
Cushing’S Syndrome ◽  
Cushing’S Disease ◽  
Adrenal Adenoma ◽  
Cushing's Syndrome ◽  
Cushing's Disease ◽  
Simultaneous Estimation ◽  
Free Cortisol ◽  
Excretion Rates

Abstract To evaluate their potential usefulness in the differential diagnosis of Cushing's syndrome, we estimated the urinary excretion rates of the following non-metabolized, unbound steroid hormones: pregnenolone, progesterone, 17-OH-pregnenolone, 17-OH-progesterone, dehydroepiandrosterone (DHEA), androstenedione, testosterone, dihydrotestosterone, 11-deoxycorticosterone, 11-deoxycortisol, corticosterone, cortisol, 18-OH-11-deoxycorticosterone, 18-OH-corticosterone, and aldosterone. These were measured in normal subjects and in patients with Cushing's disease, adrenal adenoma, or ectopic corticotropin syndrome. We used "high-performance" liquid chromatography and subsequent radioimmunoassay. Our results indicate that simultaneous estimation of urinary free cortisol and DHEA may be useful in differential diagnosis of hypercorticoid states due to adrenal adenoma and Cushing's disease.

HYPERRESPONSIVENESS TO LYSINE-VASOPRESSIN IN CUSHING'S DISEASE

1974 ◽  
Vol 75 (1) ◽  
pp. 125-132 ◽  
Author(s):  
Rafael Coslovsky ◽  
Bernardo Léo Wajchenberg ◽  
Otilia Nogueira
Keyword(s):  
Differential Diagnosis ◽  
Cushing’S Syndrome ◽  
Cushing’S Disease ◽  
Adrenocortical Carcinoma ◽  
Normal Subjects ◽  
Cushing's Syndrome ◽  
Cushing's Disease ◽  
Lysine Vasopressin ◽  
Normal Controls

ABSTRACT The lysine-8-vasopressin (LVP)-test was performed in 11 normal subjects, with pituitary-dependent Cushing's disease and in 3 cases of Cushing's syndrome due to an adrenocortical carcinoma. The plasma 17-hydroxycorticosteroids response to LVP in Cushing's disease was compared with the response of the normal controls. It is concluded that patients with pituitary-dependent Cushing's syndrome are hyper-responsive to LVP. The possible mechanisms of this hyper-responsiveness are discussed: release of ACTH from the pituitary and/or an increased release of cortisol from the hyperplastic adrenals may occur. As expected, patients with Cushing's syndrome due to an adrenocortical carcinoma did not respond to LVP. It is suggested that the LVP-test can be used for the diagnosis of Cushing's syndrome and for the differential diagnosis between Cushing's disease and Cushing's syndrome due to an adrenocortical carcinoma, although it is recognized that in some cases this test will not be adequate.

Plasma calcitonin response to a calcium clamp in endogenous Cushing's syndrome

1986 ◽  
Vol 111 (2) ◽  
pp. 258-263 ◽  
Author(s):  
O. Tørring ◽  
E. Bucht ◽  
M. Thorén ◽  
H. E. Sjöberg
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing’S Disease ◽  
Reference Group ◽  
Adrenal Adenoma ◽  
Cushing's Syndrome ◽  
Cushing's Disease ◽  
Adrenocortical Adenoma ◽  
Basal Plasma ◽  
Group A ◽  
Carboxyl Terminal

Abstract. Basal and calcium (Ca) stimulated plasma CT concentrations have been studied in 6 premenopausal females with Cushing's disease and 3 premenopausal females with Cushing's syndrome due to an adrenocortical adenoma. Thirteen healhty premenopausal females served as a reference group. A standardized Ca-stimulus was applied to all subjects by means of the 'calcium clamp' technique. Plasma immunoreactive CT (iCT) was determined by RIA using a carboxyl terminal antiserum with 8 pg-eq/ml as detection limit. The patients with Cushing's disease had normal basal plasma iCT levels and their iCT response during the 2 h calcium clamp was within the reference range in 5 out of 6 patients, the remaining patient showed a slightly exaggerated response. The patients with adrenal adenoma had elevated plasma iCT levels in the basal state but a normal response during the calcium clamp. It is therefore less likely that the bone resorption often seen in Cushing's syndrome is due to CT deficiency.

The corticotropin-releasing factor test in the differential diagnosis of Cushing's syndrome: A comparison with the lysine-vasopressin test

1990 ◽  
Vol 123 (3) ◽  
pp. 331-338 ◽  
Author(s):  
A. Tabarin ◽  
F. San Galli ◽  
S. Dezou ◽  
F. Leprat ◽  
J.-B. Corcuff ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Cushing’S Syndrome ◽  
Cushing’S Disease ◽  
Cushing's Syndrome ◽  
Cushing's Disease ◽  
High Dose ◽  
Ectopic Acth ◽  
Ectopic Acth Secretion ◽  
Etiological Diagnosis ◽  
High Dose Dexamethasone

Abstract. The diagnostic accuracy of the CRH test was compared with that of the LVP test in 28 consecutive patients with ACTH-dependent Cushing's syndrome. A false negative response to CRH was found in 3 of 21 patients with pituitary-dependent Cushing's disease and to LVP in 4. The 7 patients with ectopic ACTH secretion were unresponsive to CRH, whereas 2 did respond to LVP. CRH and high-dose dexamethasone tests combination led to concordant results in 79% of patients. In all cases the etiological diagnosis suggested was correct. LVP and high-dose dexamethasone tests combination led to concordant results in only 71% of patients and the etiological diagnosis suggested was erroneous in one. Individual tolerance to the CRH test was also clearly better than that to the LVP test. It is concluded that the CRH test, alone or in combination with the high-dose dexamethasone test must be preferentially used to the LVP test in the differential diagnosis of ACTH-dependent Cushing's disease.

BIOSYNTHESIS OF CORTICOIDS AND ANDROGENS IN AN ADENOMA FROM A CUSHING'S SYNDROME PATIENT

1963 ◽  
Vol 42 (2) ◽  
pp. 187-194
Author(s):  
Menek Goldstein ◽  
Marcel Gut ◽  
Ralph I. Dorfman ◽  
Louis J. Soffer ◽  
J. Lester Gabrilove
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing’S Disease ◽  
Cushing's Syndrome ◽  
Cushing's Disease ◽  
Syndrome Patient ◽  
Adrenal Tissue

ABSTRACT Incubation of cholesterol-4-14C and pregnenolone-7-3H with a homogenate of adenomatous adrenal tissue from a patient with Cushing's disease yielded 14C and 3H labelled, cortisol, cortisone, 11-deoxycortisol, deoxycorticosterone, dehydroepiandrosterone, and 11β-hydroxy-androst-4-3,17-dione.

Pitfalls in the diagnosis and management of Cushing's syndrome

2015 ◽  
Vol 38 (2) ◽  
pp. E4 ◽  
Author(s):  
Vivek Bansal ◽  
Nadine El Asmar ◽  
Warren R. Selman ◽  
Baha M. Arafah
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing’S Disease ◽  
Salivary Cortisol ◽  
Clinical Symptoms ◽  
Cushing's Syndrome ◽  
Cushing's Disease ◽  
Biochemical Tests ◽  
Late Night ◽  
Late Night Salivary Cortisol ◽  
Free Cortisol

Despite many recent advances, the management of patients with Cushing's disease continues to be challenging. Cushing's syndrome is a complex metabolic disorder that is a result of excess glucocorticoids. Excluding the exogenous causes, adrenocorticotropic hormone–secreting pituitary adenomas account for nearly 70% of all cases of Cushing's syndrome. The suspicion, diagnosis, and differential diagnosis require a logical systematic approach with attention paid to key details at each investigational step. A diagnosis of endogenous Cushing's syndrome is usually suspected in patients with clinical symptoms and confirmed by using multiple biochemical tests. Each of the biochemical tests used to establish the diagnosis has limitations that need to be considered for proper interpretation. Although some tests determine the total daily urinary excretion of cortisol, many others rely on measurements of serum cortisol at baseline and after stimulation (e.g., after corticotropin-releasing hormone) or suppression (e.g., dexamethasone) with agents that influence the hypothalamic-pituitary-adrenal axis. Other tests (e.g., measurements of late-night salivary cortisol concentration) rely on alterations in the diurnal rhythm of cortisol secretion. Because more than 90% of the cortisol in the circulation is protein bound, any alteration in the binding proteins (transcortin and albumin) will automatically influence the measured level and confound the interpretation of stimulation and suppression data, which are the basis for establishing the diagnosis of Cushing's syndrome. Although measuring late-night salivary cortisol seems to be an excellent initial test for hypercortisolism, it may be confounded by poor sampling methods and contamination. Measurements of 24-hour urinary free-cortisol excretion could be misleading in the presence of some pathological and physiological conditions. Dexamethasone suppression tests can be affected by illnesses that alter the absorption of the drug (e.g., malabsorption, celiac disease) and by the concurrent use of medications that interfere with its metabolism (e.g., inducers and inhibitors of the P450 enzyme system). In this review, the authors aim to review the pitfalls commonly encountered in the workup of patients suspected to have hypercortisolism. The optimal diagnosis and therapy for patients with Cushing's disease require the thorough and close coordination and involvement of all members of the management team.

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