CUSHING'S SYNDROME FOLLOWING PARTIAL ADRENALECTOMY AND COMPLETE HYPOPHYSECTOMY

1965 ◽  
Vol 48 (4) ◽  
pp. 565-568 ◽  
Author(s):  
W. A. Sullivan ◽  
Jerrold D. Hydovitz ◽  
H. Rosomoff ◽  
T. S. Danowski
Keyword(s):  
Cushing’S Syndrome ◽  
Adult Male ◽  
Successful Treatment ◽  
Cushing's Syndrome ◽  
Partial Adrenalectomy ◽  
The Third ◽  
Subtotal Adrenalectomy ◽  
Pituitary Ablation ◽  
Acth Secreting

ABSTRACT A third episode of Cushing's syndrome developed in an adult male who had undergone subtotal adrenalectomy and then complete hypophysectomy in temporarily successful treatment of two earlier episodes. Judging from necropsy findings, this final recurrence was not the result of incomplete pituitary ablation or regeneration of pituitary remnants. Extrasellar pituitary or other ACTH secreting tissue could not be identified, but the patient's marked melanosis suggested its presence with consequent excesses of ACTH or MSH. However, irrespective of whether such excesses did or did not exist, it is clear that the third episode of Cushing's syndrome resulted from hyperfunction of the small adrenal remnant.

Cushing's Syndrome Due to an ACTH-secreting Adrenal Medullary Tumour

1980 ◽  
Vol 10 (6) ◽  
pp. 654-656 ◽  
Author(s):  
L. Hoffman ◽  
F. I. R. Martin ◽  
M. R. C. Buchanan ◽  
A. Butkus ◽  
J. A. Whitworth
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Acth Secreting

scholarly journals The role of bilateral inferior petrosal sinus sampling in the diagnosis of Cushing's syndrome

2007 ◽  
Vol 51 (8) ◽  
pp. 1329-1338 ◽  
Author(s):  
Andrea Utz ◽  
Beverly M.K. Biller
Keyword(s):  
Cushing’S Syndrome ◽  
Venous Drainage ◽  
Cushing's Syndrome ◽  
Blood Levels ◽  
Inferior Petrosal Sinus ◽  
Ectopic Acth ◽  
Inferior Petrosal Sinus Sampling ◽  
Neoplastic Lesion ◽  
Before And After ◽  
Acth Secreting

Adrenocorticotropin hormone (ACTH)-dependent Cushing's syndrome is most often due to a pituitary corticotroph adenoma, with ectopic ACTH-secreting tumors representing approximately 15% of cases. Biochemical and radiological techniques have been established to help distinguish between these two entities, and thus aid in the localization of the neoplastic lesion for surgical resection. The test that offers the highest sensitivity and specificity is bilateral inferior petrosal sinus sampling (BIPSS). BIPSS is an interventional radiology procedure in which ACTH levels obtained from venous drainage very near the pituitary gland are compared to peripheral blood levels before and after corticotropin hormone (CRH) stimulation. A gradient between these two locations indicates pituitary Cushing's, whereas the absence of a gradient suggests ectopic Cushing's. Accurate BIPSS results require hypercortisolemia to suppress normal corticotroph ACTH production and hypercortisolemia at the time of the BIPSS to assure excessive ACTH secretion. In some cases, intrapituitary gradients from side-to-side can be helpful to localize small corticotroph adenomas within the sella. BIPSS has rare complications and is considered safe when performed at centers with experience in this specialized technique.

scholarly journals Dexmedetomidine for Conscious Sedation in Bilateral Inferior Petrosal Sinus Sampling

2016 ◽  
Vol 1 (2) ◽  
pp. 61-62
Author(s):  
Neeraj Barnwal ◽  
Raylene Dias ◽  
Rahul Mamde
Keyword(s):  
General Anesthesia ◽  
Cushing’S Syndrome ◽  
Conscious Sedation ◽  
Cushing's Syndrome ◽  
Inferior Petrosal Sinus ◽  
The Novel ◽  
Rare Presentation ◽  
Inferior Petrosal Sinus Sampling ◽  
Ectopic Adrenocorticotropic Hormone ◽  
Acth Secreting

ABSTRACT Cushing's syndrome in an acromegalic patient is a very rare presentation. To differentiate a Cushing's disease from Cushing's syndrome due to ectopic adrenocorticotropic hormone (ACTH) secreting tumors, inferior petrosal sinus sampling (IPSS) is required. Acromegaly patients have associated airway abnormalities posing a challenge to administration of anesthesia. Traditionally, most IPSS was done under general anesthesia. But now it is being recognized that general anesthesia for this procedure has its own implications and hence conscious sedation is being used for this purpose. We describe our experience with the novel agent dexmedetomidine for conscious sedation in this procedure. How to cite this article Barnwal N, Dias R, Mamde R. Dexmedetomidine for Conscious Sedation in Bilateral Inferior Petrosal Sinus Sampling. Res Inno in Anesth 2016;1(2):61-62.

IDENTIFICATION AND SIGNIFICANCE OF PAROTID FLUID CORTICOSTEROIDS

1964 ◽  
Vol 46 (3) ◽  
pp. 393-404 ◽  
Author(s):  
Fred H. Katz ◽  
Ira L. Shannon
Keyword(s):  
Intravenous Injection ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Third Trimester ◽  
Acth Stimulation ◽  
The Third ◽  
Appreciable Quantity ◽  
Normal Men

ABSTRACT Parotid fluid, which can be collected in continuous fashion, was previously shown to possess free 17-hydroxycorticosteroid (17-OH-CS) levels which paralleled those in serum and reached a maximum two hours after corticotrophin or cortisol administration to normal men. The present study demonstrates that intravenously administered cortisol rapidly appears in parotid fluid, and that, thus, parotid fluid 17-OH-CS levels would serve as reliable indicators of plasma corticosteroid levels. This was borne out by ACTH stimulation studies in patients with Cushing's Syndrome as well as adrenal hyporesponsiveness. In the third trimester of pregnancy, despite the large rise in plasma 17-OH-CS, there was only a small, though significant, increase in parotid fluid 17-OH-CS. Conjugated 17-OH-CS were not found in appreciable quantity in parotid fluid. Chemical and radioisotopic techniques indicated cortisol and cortisone to be the major human parotid fluid 17-OH-CS. Parotid tissue from the dog converted cortisol to cortisone. Radioactive aldosterone, oestrogen and androgen also appeared in parotid fluid after intravenous injection.

Ectopic ACTH-secreting tumor of the thymus revealed by a Cushing’s syndrome: case report and review of literature

2017 ◽  
Vol 34 (1) ◽  
pp. 65-68
Author(s):  
Zied Chaari ◽  
Hazem Zribi ◽  
Sonia Ouerghi ◽  
Mohamed-Sadok Boudaya ◽  
Tarek Kilani ◽  
...  
Keyword(s):  
Case Report ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Review Of Literature ◽  
Ectopic Acth ◽  
Acth Secreting

DETECTION OF AN ACTH-SECRETING BRONCHIAL CARCINOID TUMOUR EIGHTEEN MONTHS AFTER ADRENALECTOMY FOR CUSHING'S SYNDROME

1971 ◽  
Vol 67 (4) ◽  
pp. 625-633 ◽  
Author(s):  
A. C. M. Vingerhoeds ◽  
P. J. der Kinderen ◽  
J. H. H. Thijssen ◽  
F. Schwarz
Keyword(s):  
Differential Diagnosis ◽  
Cushing’S Syndrome ◽  
Carcinoid Tumour ◽  
Cushing's Syndrome ◽  
Bronchial Carcinoid ◽  
Laboratory Methods ◽  
Ectopic Cushing’S Syndrome ◽  
Course Of Action ◽  
Ablative Surgery ◽  
Acth Secreting

ABSTRACT A patient is described in whom an ACTH-producing bronchial carcinoid tumour was found eighteen months after bilateral adrenalectomy for Cushing's syndrome. A critical review is given of laboratory methods used in the differential diagnosis of ectopic Cushing's syndrome. Finally a course of action is suggested by which such unnecessary ablative surgery might be avoided.

scholarly journals Cyclic Cushing's disease with misleading inferior petrosal sinus sampling results during a trough phase

2015 ◽  
Vol 38 (2) ◽  
pp. E7 ◽  
Author(s):  
Vivien Bonert ◽  
Namrata Bose ◽  
John D. Carmichael
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing’S Disease ◽  
Adrenocorticotropic Hormone ◽  
Diagnostic Testing ◽  
Cushing's Syndrome ◽  
Cushing's Disease ◽  
Inferior Petrosal Sinus ◽  
Inferior Petrosal Sinus Sampling ◽  
Acth Secreting ◽  
Transsphenoidal Resection

Diagnosing Cushing's syndrome is challenging and is further hampered when investigations are performed in a patient with cyclic Cushing's syndrome. A subset of patients with Cushing's syndrome exhibit periods of abnormal cortisol secretion with interspersed normal secretion. Patients can have periods of clinical improvement during these quiescent phases or remain symptomatic. Initial diagnostic testing can be challenging because of the unpredictable durations of the peak and trough phases, and it is especially challenging when the diagnosis of cyclic Cushing's syndrome has not yet been determined. Here, the authors present the case of a patient with Cushing's disease with a pathology-proven adrenocorticotropic hormone (ACTH)–secreting pituitary adenoma and whose initial inferior petrosal sinus sampling (IPSS) results were deemed indeterminate; further studies elucidated the diagnosis of cyclic Cushing's syndrome. Repeat IPSS was diagnostic of a central source for ACTH secretion, and the patient was treated successfully with transsphenoidal resection. Literature concerning the diagnosis and management of cyclic Cushing's syndrome is also reviewed.

Cushing's syndrome secondary to ACTH-secreting Wilms' tumor

1974 ◽  
Vol 9 (4) ◽  
pp. 535-539 ◽  
Author(s):  
Genevieve E. Cummins ◽  
Douglas Cohen
Keyword(s):  
Cushing’S Syndrome ◽  
Wilms Tumor ◽  
Cushing's Syndrome ◽  
Acth Secreting

scholarly journals New developments in the medical treatment of Cushing's syndrome

2012 ◽  
Vol 19 (6) ◽  
pp. R205-R223 ◽  
Author(s):  
R van der Pas ◽  
W W de Herder ◽  
L J Hofland ◽  
R A Feelders
Keyword(s):  
Medical Treatment ◽  
Medical Therapy ◽  
Cushing’S Syndrome ◽  
Treatment Options ◽  
Cushing's Syndrome ◽  
Treatment Modalities ◽  
Primary Therapy ◽  
Ectopic Acth ◽  
Considerable Morbidity ◽  
Acth Secreting

Cushing's syndrome (CS) is a severe endocrine disorder characterized by chronic cortisol excess due to an ACTH-secreting pituitary adenoma, ectopic ACTH production, or a cortisol-producing adrenal neoplasia. Regardless of the underlying cause, untreated CS is associated with considerable morbidity and mortality. Surgery is the primary therapy for all causes of CS, but surgical failure and ineligibility of the patient to undergo surgery necessitate alternative treatment modalities. The role of medical therapy in CS has been limited because of lack of efficacy or intolerability. In recent years, however, new targets for medical therapy have been identified, both at the level of the pituitary gland (e.g. somatostatin, dopamine, and epidermal growth factor receptors) and the adrenal gland (ectopically expressed receptors in ACTH-independent macronodular adrenal hyperplasia). In this review, results of preclinical and clinical studies with drugs that exert their action through these molecular targets, as well as already established medical treatment options, will be discussed.

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