STEROID SYNTHESIS IN A HUMAN VIRILISING ADRENAL CARCINOMA – SOME UNUSUAL FEATURES

1970 ◽  
Vol 65 (1) ◽  
pp. 133-147 ◽  
Author(s):  
E. H. D. Cameron ◽  
J. Hammerstein ◽  
D. Jones ◽  
S. Morris ◽  
K. Griffiths
Keyword(s):  
Tennis Ball ◽  
Adrenal Carcinoma ◽  
Steroid Synthesis ◽  
Ball Size ◽  
Steroid Analysis ◽  
History Of ◽  
Suppression Test ◽  
Dexamethasone Suppression ◽  
Adrenal Hyperfunction

ABSTRACT A patient presenting at the Universitäts-Frauenklinik, Berlin with a long history of increasing hirsutism and virilism provided an opportunity to study an unusual form of adrenal hyperfunction. It was found that she behaved abnormally with respect to the dexamethasone suppression test since her highly elevated 17-oxosteroid output further increased by approximately 400% with 8 mg/day dosage. Her basal 17-hydroxycorticosteroid output was elevated but not grossly so, nor did she exhibit the usual signs of Cushing's syndrome of weight increase and florid complexion. At operation a »tennis ball« size adrenal carcinoma was removed from the left side. Incubation studies were performed on sliced tumour tissue with substrates [1-14C] acetate, [7α-3H] pregnenolone, [4-14C] progesterone and [4-14C] androst-4-ene-3,17-dione. The frozen incubation mixtures were subsequently flown to Cardiff for steroid analysis by reverse radioisotope dilution techniques. The combined urinary and incubation results suggested that, in vivo, the tumour secreted DHA and not DHA sulphate and that there appeared to be a considerable deficiency of DHA-3β-hydroxysteroid dehydrogenase/Δ5−4-isomerase and of DHA-3β-sulphokinase activities although the steroid-11β-hydroxylase, 17α-hydroxylase and 21-hydroxylase activities seemed unimpaired.

Biochemically silent phaeochromocytoma presenting with non-specific loin pain

2021 ◽  
Vol 14 (8) ◽  
pp. e244258
Author(s):  
Annalisa Montebello ◽  
Etienne Ceci Bonello ◽  
Miriam Giordano Imbroll ◽  
Mark Gruppetta
Keyword(s):  
Adrenal Adenoma ◽  
Dexamethasone Suppression Test ◽  
Adrenal Lesion ◽  
Genetic Mutations ◽  
Large Size ◽  
History Of ◽  
Loin Pain ◽  
Suppression Test ◽  
Aldosterone To Renin Ratio ◽  
Dexamethasone Suppression

A 55-year-old woman presented with a 4-month history of right-sided non-specific loin pain and 6 kg weight loss. A CT scan of the abdomen and pelvis showed an incidental 4.5 cm right-sided adrenal lesion which was not typical of an adrenal adenoma. This was further confirmed on MRI of the adrenals. Biochemical investigations to investigate for a functional adrenal lesion included serum catecholamines and metanephrines, an aldosterone to renin ratio and an overnight dexamethasone suppression test. These were all negative. A laparoscopic adrenalectomy was performed in view of the large size of the lesion. Histology was consistent with a phaeochromocytoma, which confirmed the diagnosis of a non-secreting phaeochromocytoma. Non-secreting phaeochromocytomas are rare and usually found in patients with known genetic mutations. Adrenal lesions not related to any mutations similar to our case are even rarer and reported even less in the literature.

Pre-Pubertal Depressive Stupor: A Case Report

1988 ◽  
Vol 153 (5) ◽  
pp. 689-692 ◽  
Author(s):  
J. C. Powell ◽  
W. R. Silveira ◽  
R. Lindsay
Keyword(s):  
Case Report ◽  
Family History ◽  
Affective Disorder ◽  
Dexamethasone Suppression Test ◽  
Clinical State ◽  
Affective Illness ◽  
History Of ◽  
Suppression Test ◽  
Dexamethasone Suppression ◽  
Maternal Side

A case of childhood affective disorder with episodes of depressive stupor in a 13-year-old pre-pubertal boy is described. Changes in the patient's clinical state were accompanied by changes in the dexamethasone suppression test. A family history of affective illness on the maternal side, with phenomenological similarities, is noted.

scholarly journals Cushing Syndrome in the Setting of Chronic Dilated Cardiomyopathy: Can Treatment Improve Chronic Dilated Cardiomyopathy?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A125-A126
Author(s):  
Leilani Pathak ◽  
Shikha Singh ◽  
Lina Soni ◽  
Ying Yin Zhou ◽  
Samara Skwiersky
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Dilated Cardiomyopathy ◽  
Cushing Syndrome ◽  
Definitive Treatment ◽  
Reduced Ejection Fraction ◽  
Morning Cortisol ◽  
History Of ◽  
Suppression Test ◽  
Dexamethasone Suppression

Abstract Background: Cushing syndrome (CS) is well known to be associated with metabolic syndrome, venous thromboembolism, hypertension, left ventricular hypertrophy, and rarely dilated cardiomyopathy. The pathophysiological effects of hypercortisolism on the myocardium results in cardiomyocyte hypertrophy, myofibrillolysis, myocardial fibrosis, global longitudinal and circumferential strain. Our patient presents an example of CS in the setting of chronic heart failure with reduced ejection fraction, multiple thromboembolic events, and diabetes mellitus in a young adult. Clinical Case: A 34-year male with a past medical history of dilated cardiomyopathy with biventricular failure and left ventricle ejection fraction of 10%, pulmonary embolism, diabetes mellitus, and gout presented with shortness of breath. On physical exam he presented with symptoms of CS: moon facies, supraclavicular fat pads, dorsal fat pads, purple striae of abdominal skin, truncal obesity, ecchymosis, and skin atrophy. Labs showed elevated morning cortisol after overnight 1 mg dexamethasone suppression test (cortisol 8.6 mcg/dl, n< 5 mcg/dl), repeat morning cortisol after overnight 1 mg dexamethasone suppression test (cortisol 5.7 mcg/dl, n< 5 mcg/dl), and ACTH-concentrations <5 pg/ml. CT-scan was insignificant for adrenal hyperplasia. He was admitted and treated for acute congestive heart failure exacerbation with plans for definitive treatment of CS outpatient with further imaging studies. Conclusion: The occurrence of CS induced heart failure results in increased mortality. There have been numerous accounts of resolution of cardiomyopathy after surgical treatment for CS secondary to adrenal adenoma. Our patient had a 10-year history of chronic dilated cardiomyopathy prior to cushingoid symptoms and confirmatory endocrinological data. The definitive treatment for CS syndrome in our patient would eventually be surgery targeting the source of hypercortisolism, however his cardiovascular risk factors would make him a poor surgical candidate. Severely reduced ejection fraction is a contraindication for generalized anesthesia needed for surgery. When surgery is contraindicated in CS medical management is recommended according to guidelines that target pituitary-directed medical treatments for Cushing’s disease and targeted therapies to treat ectopic ACTH syndrome. To our knowledge there have been few studies that demonstrate the effects of CS treatment on chronic conditions such as dilated cardiomyopathy. Studies have shown that surgical treatment for CS have reversed cardiomyopathy caused by CS but it still remains to be answered whether this same effect is achieved to some degree in chronic dilated cardiomyopathy.

scholarly journals Neuroendocrine predictors of the evolution of depression

2005 ◽  
Vol 7 (3) ◽  
pp. 273-282
Keyword(s):  
Significant Proportion ◽  
Residual Symptoms ◽  
Dopaminergic Systems ◽  
Therapeutic Choice ◽  
Treatment Of Depression ◽  
Suppression Test ◽  
Challenge Tests ◽  
Dexamethasone Suppression ◽  
Biological State

Depression is both clinically and biologically a heterogeneous entity. Despite advances in psychopharmacology, a significant proportion of depressed patients either continue to have residual symptoms or do not respond to antidepressants. It has therefore become essential to determine parameters (or predictors) that would rationalize the therapeutic choice, taking into account not only the clinical features, but also the "biological state," which is a major determinant in the antidepressant response. Such predictors can derive from bioclinical correlates and, in this context, the neuroendocrine strategy appears particularly suited. Numerous studies have investigated neuroendocrine parameters--derived mainly from dynamic challenge tests--in order to (i) determine the predictive profiles of good clinical responders to given antidepressants; (ii) monitor the progression of markers in parallel with the clinical outcome; and (iii) evaluate "in vivo" in humans the mechanisms of action of antidepressant compounds (before, during, and after treatment). This article does not attempt to be exhaustive, but rather uses selected examples to illustrate the usefulness of the investigation of the adrenal and thyroid axes and the assessment of central serotonergic, noradrenergic, and dopaminergic systems by means of neuroendocrine tests. Given methodological constraints, most of these investigations--except for baseline hormone values and the dexamethasone suppression test--cannot be used routinely in psychiatry. Despite these limitations, the neuroendocrine strategy still offers new insights in biology and the treatment of depression. Its possible expansion depends mainly on the development of specific agonists or antagonists for better investigation of the receptors supposedly involved in the pathophysiology of depression. These investigations will help define more homogeneous subgroups from a bioclinical and therapeutic viewpoint.

Adrenal Pheochromocytoma With Contralateral Adrenocortical Adenoma in a Cat

2010 ◽  
Vol 46 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Jon David R. Calsyn ◽  
Rebecca A. Green ◽  
Garrett J. Davis ◽  
Christopher M. Reilly
Keyword(s):  
Adrenal Gland ◽  
Low Dose ◽  
Clinical Signs ◽  
Adrenocortical Adenoma ◽  
Left Adrenal Gland ◽  
Adrenal Pheochromocytoma ◽  
History Of ◽  
Suppression Test ◽  
The Right ◽  
Dexamethasone Suppression

A 7-year-old, neutered male cat was presented with a 6-month history of progressive polyuria, polydipsia, polyphagia, aggression, and weight gain. Previous blood work, urinalysis, and radiographs did not delineate a cause for the clinical signs. An ultrasound revealed bilateral adrenal gland enlargement. A low-dose dexamethasone suppression test was consistent with hyperadrenocorticism. Based on these findings, bilateral adrenalectomy was attempted and successfully performed. Histopathology was consistent with a cortical adenoma in the right adrenal gland and a pheochromocytoma in the left adrenal gland. This association has never been reported in the cat.

Dexamethasone suppression test and suicide attempts in schizophrenic patients

2001 ◽  
Vol 16 (7) ◽  
pp. 428-431 ◽  
Author(s):  
M. Płocka-Lewandowska ◽  
A. Araszkiewicz ◽  
J.K. Rybakowski
Keyword(s):  
Suicide Attempt ◽  
Suicide Attempts ◽  
Dexamethasone Suppression Test ◽  
Course Of Illness ◽  
Future Attempt ◽  
Schizophrenic Patients ◽  
History Of ◽  
Suppression Test ◽  
Cortisol Levels ◽  
Dexamethasone Suppression

SummaryThe suicide attempts were assessed in 32 schizophrenic patients on whom the dexamethasone suppression test (DST) was done twice in the course of illness: in the years 1985–91 and 1996–97. In the 1985–91 period, both baseline and post-dexamethasone cortisol levels were significantly higher in the patients with previous suicide attempts and baseline cortisol was higher in the patients who were to make a future attempt. In 1996–97, DST non-suppression was shown in more than half of the patients with a history of suicide attempt and in none of those without such history: all cortisol levels were significantly higher in the patients with a history of suicide attempt. Although the mean intensity of depression was higher in the patients with a history of suicide attempt, no association between the intensity of depression and present or previous DST non-suppression status was found. It is suggested that the hyperactivity of the hypothalamic-pituitary-adrenal axis may constitute an element of diathesis for suicidal behavior in schizophrenic patients.

Depression, Weight Loss and the Dexamethasone Suppression Test

1984 ◽  
Vol 145 (1) ◽  
pp. 88-90 ◽  
Author(s):  
Alec Coppen ◽  
Janet Harwood ◽  
Keith Wood
Keyword(s):  
Weight Loss ◽  
Major Depressive Disorder ◽  
Depressive Illness ◽  
Dexamethasone Suppression Test ◽  
Necessary Condition ◽  
Major Depressive ◽  
Significant Difference ◽  
History Of ◽  
Suppression Test ◽  
Dexamethasone Suppression

SummaryThe dexamethasone suppression test (DST) was carried out on 143 patients with a major depressive disorder, who were classified into those with a history of weight loss (n = 89) and those without (n = 54). Seventy-three per cent of patients with weight loss and 61% of patients without had an abnormal DST; this difference was not statistically significant. Of the patients receiving prophylactic lithium therapy, 13 were found to have changed their DST status on retesting after a period of 14 months, but there was no significant difference in their weight. It is concluded that weight loss is not a necessary condition for an abnormal DST in depressive illness.

scholarly journals Co-Occurrence of Exogenous and Endogenous Cushing’s Syndromes—Dilemma in Diagnosis

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Chin Voon Tong ◽  
Subashini Rajoo
Keyword(s):  
Cushing’S Syndrome ◽  
Adrenal Adenoma ◽  
Cushing's Syndrome ◽  
Dexamethasone Suppression Test ◽  
Adrenal Cortical Adenoma ◽  
Thin Skin ◽  
History Of ◽  
Musculoskeletal Manifestations ◽  
Suppression Test ◽  
Dexamethasone Suppression

Approach to patients who manifest with features of Cushing’s syndrome often begin with exclusion of exposure to excessive exogenous source of glucocorticoids (GC). Most guidelines advocate no further assessment if excessive exogenous GC use is present. We present a case of a 66-year-old lady who was noted to have typical features of Cushing’s syndrome. As she gave a very clear history of ingesting exogenous GC for a year, no further work up was undertaken. Despite cessation of GC for a year, she continued to have thin skin and easy bruising. Upon admission for hypertensive emergency, her clinician took note of her changes and investigated her for endogenous Cushing’s syndrome. Her cortisol post overnight dexamethasone suppression test was 707 nmol/l. Post low dose dexamethasone suppression test yielded a cortisol of 1133.2 nmol/l. 24 hours urine cortisol was 432.2 nmol/l. Plasma ACTH was 1.1 pmol/l, indicating an ACTH independent Cushing’s syndrome. We proceeded with Computed tomography scan (CT scan) of adrenals which revealed a right adrenal adenoma measuring 4.4 × 3.4 × 4.0 cm. Right retroperiteneoscopic adrenalectomy was done. Histopathology examination was consistent with adrenal cortical adenoma with foci of myelolipoma. Post adrenalectomy she developed hypocortisolism secondary to contralateral adrenal suppression which lasted up to the present date. Her cutaneous and musculoskeletal manifestations improved substantially. Co-occurrence of endogenous and exogenous Cushing’s syndromes is uncommon but should be considered in patients whose Cushingnoid features do not resolve after cessation of exogenous GC.

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