INSULIN STIMULATION TESTS IN PITUITARY DEPENDENT CUSHING'S SYNDROME AFTER COMPLETE ADRENALECTOMY

1977 ◽  
Vol 86 (3) ◽  
pp. 578-582 ◽  
Author(s):  
R. J. M. Croughs ◽  
H. Timmermans ◽  
A. C. M. Vingerhoeds ◽  
A. Vermeulen ◽  
A. Smals ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Similar Magnitude ◽  
Insulin Stimulation ◽  
Plasma Acth ◽  
Stimulation Tests ◽  
The Central Nervous System ◽  
Previously Treated ◽  
Per Se ◽  
Adrenocortical System

ABSTRACT The present study shows that in a group of 6 euadrenal patients, previously treated by complete adrenalectomy for pituitary dependent Cushing's syndrome, the stress stimulus of insulin induced hypoglycaemia is followed by a plasma ACTH response which is of similar magnitude as the response obtained with lysin-vasopressin. Both observations indicate that the central nervous system-pituitary axis is basically normal in pituitary dependent Cushing's syndrome as assessed by insulin induced hypoglycaemia. It is concluded that non-responsiveness of the pituitary-adrenocortical system to insulin induced hypoglycaemia in untreated patients with pituitary dependent Cushing's syndrome does not represent a fundamental defect of the stress mechanism, but is due to hypercorticism per se.

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.

TREATMENT OF A CASE OF NONTUMOROUS CUSHING'S SYNDROME WITH o,p'DDD

PEDIATRICS ◽  
1964 ◽  
Vol 33 (2) ◽  
pp. 239-244
Author(s):  
J. Bar-Hay ◽  
A. Benderly ◽  
G. Rumney
Keyword(s):  
Adrenal Gland ◽  
Cushing’S Syndrome ◽  
Clinical Picture ◽  
Cushing's Syndrome ◽  
Acth Stimulation ◽  
Dramatic Effect ◽  
Urinary Steroids ◽  
Stimulation Tests

A case of a nontumorous Cushing's syndrome in a 10-year-old girl is presented. The diagnosis was based on the clinical picture, the high levels of urinary steroids and plasma 17-OH corticosteroids, the results of ACTH stimulation tests, and finally by the histology of the left adrenal. Therapy with o,p'DDD had a dramatic effect on the patient's condition. The typical signs of Cushing's syndrome disappeared, and the girl is developing normally. The urinary steroids and the plasma 17-OH corticosteroids returned to normal levels. The ACTH stimulation tests gave results indicative of a normally functioning adrenal gland.

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.

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

2009 ◽  
Vol 160 (6) ◽  
pp. 891-898 ◽  
Author(s):  
Giorgio Arnaldi ◽  
Giacomo Tirabassi ◽  
Roberta Papa ◽  
Giorgio Furlani ◽  
Laura Trementino ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing’S Disease ◽  
Peak Plasma ◽  
Serum Cortisol ◽  
Cushing's Syndrome ◽  
Peak Serum ◽  
Cushing's Disease ◽  
Corticotropin Releasing Hormone ◽  
Plasma Acth ◽  
Releasing Hormone

ObjectiveCorticotropin 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).DesignRetrospective/prospective study.Subjects and methodsWe studied 51 subjects with CD, 7 with EAS, 26 with PC, and 31 controls (CT). Human CRH (hCRH) test was performed at 0830 h by measuring plasma ACTH and serum cortisol at −15, 0, 15, 30, 45, 60, 90, and 120 min.ResultsThe area under the curve–ACTH exhibited a significant negative correlation with baseline serum cortisol in CT and PC, but not in CD or EAS patients. ACTH response to hCRH was blunted in PC compared with CT, whereas peak serum cortisol was higher in PC than in CT subjects. These findings suggested that ACTH-dependent Cushing's syndrome can be diagnosed by the presence of two hCRH test parameters and excluded if either or both are absent. Application of i) basal serum cortisol >12 μg/dl and peak plasma ACTH >54 pg/ml, or ii) peak serum cortisol >21 μg/dl and peak plasma ACTH >45 pg/ml, had 91.3% (95% confidence intervals (CI) 81–97.1) and 94.8% (CI 85.6–98.9) sensitivity and 98.2% (CI 90.6–99.9) and 91.2% (CI 80.7–97) specificity respectively, in diagnosing ACTH-dependent Cushing's syndrome. The >14% serum cortisol increase from mean baseline values to the mean of 15 and 30 min values in patients who were positive for the test completely discriminated between CD and EAS.ConclusionsSimultaneous plasma ACTH and serum cortisol analysis enables the hCRH test to distinguish CD from PC and from normality, while preserving its ability to discriminate CD from EAS.

scholarly journals Analytical and clinical aspects of adrenocorticotrophin determination

2003 ◽  
Vol 40 (5) ◽  
pp. 453-471 ◽  
Author(s):  
JA Talbot ◽  
JW Kane ◽  
A White
Keyword(s):  
Cushing’S Syndrome ◽  
Early Morning ◽  
Cushing's Syndrome ◽  
Clinical Aspects ◽  
Plasma Acth ◽  
Immunological Recognition ◽  
Clinical Conditions ◽  
Methodological Aspects

Adrenocorticotrophin (ACTH) is formed from the cleavage of pro-opiomelanocortin. Measurement of plasma ACTH is a key step in the differential diagnosis of hypothalamic-pituitary-adrenal disorders. Prior to the development of radioimmunoassay, the bioassays employed for the determination of ACTH were highly complex, time-consuming and costly in terms of number of animals used. Their sensitivity was such that the normal early morning peak of ACTH could not be determined. The introduction of immunoassay methodology enabled the measurement of low normal ACTH concentrations. Immunological recognition of ACTH by the antibodies employed offered improvements with regard to specificity. The development of two-site immunometric assays further improved specificity and the ability to measure low normal ACTH concentrations without the need to extract large volumes of plasma. The quantification of ACTH is now routinely performed in clinical laboratories, with non-radioisotopic methods becoming increasingly popular. ACTH measurement is of limited value in distinguishing between the causes of Cushing's syndrome, as there is considerable overlap in circulating ACTH concentrations in subjects with either a pituitary or an ectopic tumour. The role of ACTH precursor and related peptides in normal and pathological states and the clinical utility of their measurement remain to be fully elucidated. However, there is evidence that measurement of ACTH precursors can be a useful diagnostic tool in identifying the aetiology of Cushing's syndrome. This review will primarily address methodological aspects of ACTH measurement in the diagnosis of clinical conditions.

Hyperfunctioning unilateral adrenal macronodule in three patients with Cushing's disease: hormonal and imaging characterization

1993 ◽  
Vol 129 (4) ◽  
pp. 284-290 ◽  
Author(s):  
Roger Abs ◽  
Frank Nobels ◽  
Johan Verhelst ◽  
Philippe Chanson ◽  
Charles Mahler ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Ct Scanning ◽  
Serum Cortisol ◽  
Cushing's Syndrome ◽  
Cushing's Disease ◽  
Cortisol Secretion ◽  
Inferior Petrosal Sinus ◽  
Plasma Acth ◽  
Inferior Petrosal Sinus Sampling ◽  
Adrenal Nodule

We aimed to investigate the dynamics of adrenocorticotropin (ACTH) and cortisol secretion in pituitary-dependent Cushing's syndrome with bilateral macronodular adrenal hyperplasia presenting as a single adrenal macronodule, and to determine the imaging characteristics of this syndrome. Three female patients were studied. Plasma ACTH and serum cortisol secretion were studied by determining their rhythmicity and pulsatility and their responses to the administration of ovine corticotropin-releasing factor, thyrotropin-releasing hormone, metyrapone, tetracosactrin, insulin and dexamethasone. Techniques used to localize the anatomical lesion were bilateral simultaneous inferior petrosal sinus sampling, magnetic resonance examination of the pituitary, computed tomography (CT) scanning and [75Se]cholesterol scintigraphy of the adrenal glands. Plasma ACTH and serum cortisol levels were measured using a commercial radioimmunoassay and an immunoradiometric assay. The ACTH and cortisol pulse number and amplitude were calculated using established computer software. In all three patients ACTH and cortisol secretory dynamics fulfilled the requirements for diagnosis of pituitary-dependent Cushing's syndrome. A close relationship between ACTH and cortisol pulses also favored a pituitary dependency. Study of the amplitude of cortisol pulses classified two patients in the group of hypopulsatile Cushing's disease. Adrenal CT scanning demonstrated the presence of a large single nodule. [75Se]Cholesterol scintigraphy showed bilateral radionuclide uptake, although mostly localized over the adrenal nodule. All patients underwent successful trans-sphenoidal hypophysectomy. Over a period of 1 year, a slow shrinkage of the adrenal nodule was observed in two patients, while no change in volume was observed in one patient. Demonstration of an adrenal macronodule on CT scanning in patients with Cushing's syndrome is in itself insufficient to allow the diagnosis of hypercorticism due to a unilateral adrenal adenoma. Additional dynamic endocrine testing, inferior petrosal sinus sampling and imaging techniques such as [75Se]cholesterol scintigraphy remain necessary to reach a correct diagnosis.

Sign in / Sign up

Export Citation Format

Share Document