Repeated Plasma Cortisol Determinations in Cushing's Syndrome Due to Adrenocortical Adenoma

1971 ◽  
Vol 32 (5) ◽  
pp. 666-668 ◽  
Author(s):  
J. TOURNIAIRE ◽  
J. ORGIAZZI ◽  
J. F. RIVIERE ◽  
H. ROUSSET
Keyword(s):  
Cushing’S Syndrome ◽  
Plasma Cortisol ◽  
Cushing's Syndrome ◽  
Adrenocortical Adenoma

scholarly journals Clinical Characteristics of Endogenous Cushing’s Syndrome at a Medical Center in Southern Taiwan

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Shih-Chen Tung ◽  
Pei-Wen Wang ◽  
Rue-Tsuan Liu ◽  
Jung-Fu Chen ◽  
Ching-Jung Hsieh ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Cushing’S Syndrome ◽  
Plasma Cortisol ◽  
Medical Center ◽  
Cushing's Syndrome ◽  
Dexamethasone Suppression Test ◽  
Adrenocortical Adenoma ◽  
Suppression Test ◽  
Southern Taiwan ◽  
Dexamethasone Suppression

From January 1987 to December 2011, over a total of 25 years, 84 patients with Cushing’s syndrome (CS) were identified at a medical center in southern Taiwan. We observed a higher incidence of ACTH-independent CS (75%) than ACTH-dependent CS (25%). A higher incidence of adrenocortical adenoma (58.3%) than Cushing’s disease (CD, 21.4%) was also found. The sensitivity of the definitive diagnostic tests for CS, including loss of plasma cortisol circadian rhythm, a baseline 24 h urinary free cortisol (UFC) value >80 μg, and overnight and 2-day low-dose dexamethasone suppression test, was between 94.4% and 100%. For the 2-day high-dose dexamethasone suppression test for the differential diagnosis of CD, the sensitivity of 0800 h plasma cortisol and 24 h UFC was 44.4% and 85.7%, respectively. For the differential diagnosis of adrenal CS, the sensitivities of the 0800 h plasma cortisol and 24 h UFC were 95.5% and 88.9%, respectively. In patients with ACTH-independent CS and ACTH-dependent CS, the baseline plasma ACTH levels were all below 29 pg/mL and above 37 pg/mL, respectively. The postsurgical hospitalization stay following retroperitoneoscopic adrenalectomy was shorter than that observed for transabdominal adrenalectomy (4.3 ± 1.6 versus 8.8 ± 3.7 days,P<0.001). It was easy to develop retroperitoneal and peritoneal seeding of adrenocortical carcinoma via laparoscopic adrenalectomy.

PLASMA CORTISOL PROFILES IN CUSHING'S SYNDROME

1979 ◽  
Vol 91 (2) ◽  
pp. 319-328 ◽  
Author(s):  
Koichiro Yoshida ◽  
Hiroshi Satowa ◽  
Akio Sato ◽  
Yoichi Ichikawa ◽  
Jacob Kream ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Bronchogenic Carcinoma ◽  
Plasma Cortisol ◽  
Plasma Concentrations ◽  
Cushing's Syndrome ◽  
Cortisol Concentration ◽  
Adrenocortical Adenoma ◽  
Plasma Acth ◽  
Plasma Cortisol Concentration ◽  
Coefficients Of Variation

ABSTRACT Plasma cortisol profiles were studied by the frequent sampling method in 5 patients with Cushing's disease (CD), 7 patients with Cushing's syndrome due to adrenocortical adenoma (AA), and one patient with bronchogenic carcinoma. Plasma ACTH was measured by radioimmunoassay at 10 min intervals in 2 of the subjects. In CD, there was distinct episodic secretion of cortisol and ACTH; the coefficients of variation about the mean plasma cortisol concentration ranged from 24 to 27 %; plasma ACTH ranged from zero to 455 pg/ml with a mean of 94 pg/ml. In AA, the tumour secreted cortisol at a constant rate with little fluctuation; the coefficients of variation of plasma cortisol concentration ranged from 8 to 14%; plasma concentrations of ACTH were always near zero. In the patient with bronchogenic carcinoma, the coefficient of variation of cortisol was 14 %. These results were apparent even in profiles of plasma cortisol concentrations measured over only a 6 h period. It is concluded that characteristics of plasma cortisol and ACTH secretory patterns are helpful in differentiating Cushing's syndrome of differing aetiology.

DIURNAL VARIATION IN PLASMA CORTISOL AND PROLACTIN IN PATIENTS WITH CUSHING'S SYNDROME

1978 ◽  
Vol 88 (4) ◽  
pp. 737-743 ◽  
Author(s):  
Claus Hagen ◽  
Henrik Kehlet ◽  
Christian Binder
Keyword(s):  
Cushing’S Syndrome ◽  
Diurnal Rhythm ◽  
Plasma Cortisol ◽  
Normal Subjects ◽  
Cushing's Syndrome ◽  
Ectopic Acth Syndrome ◽  
Adrenocortical Adenoma ◽  
Plasma Prolactin ◽  
Ectopic Acth ◽  
Oat Cell Carcinoma

ABSTRACT To evaluate the relationship between plasma prolactin and cortisol in patients with Cushing's syndrome, the 24 h pattern of these hormones was measured in normal subjects and in 5 patients with pituitary dependent Cushing's syndrome and 2 patients with Cushing's syndrome due to an adrenocortical adenoma and ectopic secretion of ACTH. The normal subjects showed an increase in plasma prolactin during late sleep without correlation (P > 0.05) to changes in plasma cortisol. All patients had normal basal levels (between 10 a. m. and 12 p. m.) of plasma prolactin. Four of 5 patients with pituitary dependent Cushing's syndrome had an absent diurnal rhythm of plasma prolactin. One patient classified as pituitary dependent Cushing's syndrome on the basis of adrenal pathology, but pituitary independent on the basis of the dexamethasone suppression test had a normal circadian rhythm of plasma prolactin suggesting that the disease is not pituitary dependent at this stage. Two patients with pituitary independent Cushing's syndrome, one with adrenocortical adenoma and one with an oat cell carcinoma of the lung and the ectopic ACTH syndrome and very elevated plasma cortisol levels showed a normal and an absent diurnal rhythm of prolactin, respectively.

High [18F] 2-fluoro-2-deoxy-d-glucose (FDG) uptake of adrenocortical adenoma showing subclinical Cushing's syndrome

2003 ◽  
Vol 17 (5) ◽  
pp. 403-406 ◽  
Author(s):  
Akiko Shimizu ◽  
Noboru Oriuchi ◽  
Yoshito Tsushima ◽  
Tetsuya Higuchi ◽  
Jun Aoki ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Adrenocortical Adenoma ◽  
Subclinical Cushing’S Syndrome ◽  
Fdg Uptake

scholarly journals Reversible alterations in cardiac morphology and functions in a patient with Cushing's syndrome

2014 ◽  
Vol 2014 ◽  
Author(s):  
Hiroaki Iwasaki
Keyword(s):  
Cushing’S Syndrome ◽  
Interventricular Septum ◽  
Urinary Free Cortisol ◽  
Cushing's Syndrome ◽  
Left Ventricular ◽  
Multidetector Row Computed Tomography ◽  
List Type ◽  
Adrenocortical Adenoma ◽  
Cardiac Morphology ◽  
Free Cortisol

Summary A 45-year-old female was referred for endocrine evaluation of an incidental mass (31×24 mm in diameter) on the right adrenal gland. The patient was normotensive and nondiabetic, and had no history of generalised obesity (body weight, 46 kg at 20 years of age and 51.2 kg on admission); however, her waist-to-hip ratio was 0.97. Elevated urinary free cortisol levels (112–118 μg/day) and other findings indicated adrenocorticotrophic hormone-independent Cushing's syndrome due to right adrenocortical adenoma. Echocardiography before adrenalectomy revealed concentric left ventricular (LV) hypertrophy with a particular increase in interventricular septum thickness leading to impaired systolic and diastolic functions. Upon surgical remission of hypercortisolism, the asymmetric hypertrophy disappeared and the cardiac dysfunctions were considerably ameliorated. Although the mechanism(s) by which excessive cortisol contributes to LV wall thickness remain(s) unclear, serial echocardiography and cardiac multidetector-row computed tomography may support the notion that abnormal fat deposition in the myocardium owing to hypercortisolism appears to be an important factor for the reversible change in the cardiac morphology. Learning points Patients with Cushing's syndrome occasionally exhibit severe LV hypertrophy related to systolic and diastolic dysfunctions although they have neither hypertension nor diabetes mellitus. Biological remission of hypercortisolism can normalise structural and functional cardiac parameters and help in differentiating the cardiac alterations induced by excessive cortisol from those induced by other diseases. Excessive lipid accumulation within the heart before myocardial fibrosis may be implicated in reversible alterations in the cardiac morphology by Cushing's syndrome. Early diagnosis and treatment of Cushing's syndrome appear to be pivotal in preventing irreversible cardiac dysfunctions subsequent to cardiovascular events and heart failure.

Cyclic Cushing's syndrome combined with cortisol suppressible, dexamethasone non-suppressible ACTH secretion: a new variant of Cushing's syndrome

1985 ◽  
Vol 110 (3) ◽  
pp. 289-295 ◽  
Author(s):  
Hans-Udo Schweikert ◽  
Horst Lorenz Fehm ◽  
Rudolf Fahlbusch ◽  
Rainer Martin ◽  
Rainer Kolloch ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Normal Tissue ◽  
Plasma Cortisol ◽  
Cushing's Syndrome ◽  
Cortisol Secretion ◽  
Plasma Acth ◽  
Acth Secretion ◽  
Normal Response ◽  
New Variant ◽  
Marked Suppression

Abstract. A 55 year old woman with an unusual form of Cushing's disease was studied. During several periods (periods lasting up to 84 days) evidence of cortisol hypersecretion with cycles occurring every 6 days was found. Suppression of plasma cortisol through orally administered dexamethasone (up to 32 mg per day) could not be achieved either during periods of cyclic cortisol hypersecretion or during apparent remission with normal cortisol secretion. Marked suppression of plasma ACTH was measured in response to an iv infusion of 50 mg cortisol over a period of 55 min whereas a similar test with 2 mg dexamethasone (iv bolus) did not suppress ACTH secretion. Transsphenoidal exploration of the sella revealed a tumour surrounding the anterior pituitary. Examination of the pituitary showed a few tiny tumour structures embedded in normal tissue which could not be removed, when the tumour was resected selectively under preservation of normal appearing tissue. Post-operatively, clinical and chemical remission (normal response to 1 mg dexamethasone) was observed for about 4 months. Thereafter, cortisol hypersecretion occurred again necessitating bilateral adrenalectomy. Our results are compatible with the assumption that normal hypothalamic-pituitary-adrenal suppressibility with cortisol, but not with dexamethasone, was caused by the loss of feedback receptors for dexamethasone in the presence of cortisol receptors in the cells which secrete ACTH or CRF. The combination of cyclic hypercortisolism with dexamethasone non-suppressible Cushing's syndrome has not been reported before and thus represents a new variant of Cushing's syndrome.

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