scholarly journals Cortisol-related metabolic alterations assessed by mass spectrometry assay in patients with Cushing's syndrome

2017 ◽  
Vol 177 (2) ◽  
pp. 227-237 ◽  
Author(s):  
Guido Di Dalmazi ◽  
Marcus Quinkler ◽  
Timo Deutschbein ◽  
Cornelia Prehn ◽  
Nada Rayes ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Diabetic Patients ◽  
Contributing Factors ◽  
Metabolic Disturbances ◽  
Cross Sectional ◽  
Metabolic Alterations ◽  
Metabolomic Profiling ◽  
Metabolic Inflexibility

Objective Endogenous hypercortisolism is a chronic condition associated with severe metabolic disturbances and cardiovascular sequela. The aim of this study was to characterize metabolic alterations in patients with different degrees of hypercortisolism by mass-spectrometry-based targeted plasma metabolomic profiling and correlate the metabolomic profile with clinical and hormonal data. Design Cross-sectional study. Methods Subjects (n = 149) were classified according to clinical and hormonal characteristics: Cushing’s syndrome (n = 46), adrenocortical adenomas with autonomous cortisol secretion (n = 31) or without hypercortisolism (n = 27). Subjects with suspicion of hypercortisolism, but normal hormonal/imaging testing, served as controls (n = 42). Clinical and hormonal data were retrieved for all patients and targeted metabolomic profiling was performed. Results Patients with hypercortisolism showed lower levels of short-/medium-chain acylcarnitines and branched-chain and aromatic amino acids, but higher polyamines levels, in comparison to controls. These alterations were confirmed after excluding diabetic patients. Regression models showed significant correlation between cortisol after dexamethasone suppression test (DST) and 31 metabolites, independently of confounding/contributing factors. Among those, histidine and spermidine were also significantly associated with catabolic signs and symptoms of hypercortisolism. According to an discriminant analysis, the panel of metabolites was able to correctly classify subjects into the main diagnostic categories and to distinguish between subjects with/without altered post-DST cortisol and with/without diabetes in >80% of the cases. Conclusions Metabolomic profiling revealed alterations of intermediate metabolism independently associated with the severity of hypercortisolism, consistent with disturbed protein synthesis/catabolism and incomplete β-oxidation, providing evidence for the occurrence of metabolic inflexibility in hypercortisolism.

scholarly journals Frequency of Osteoporosis in Iatrogenic Cushing’s syndrome: Scenario of outpatient department in urban hospitals

2020 ◽  
Vol 31 (1) ◽  
pp. 18-21
Author(s):  
Tamanna Bahar ◽  
Shaila Rahman ◽  
Lilian Catherene Gomes ◽  
Mohammad Murad Hossain ◽  
Zulfia Zinat Chowdhury ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing Syndrome ◽  
Reference Population ◽  
Final Diagnosis ◽  
Cushing's Syndrome ◽  
Outpatient Department ◽  
Clinical Feature ◽  
Cross Sectional ◽  
Prevalence Of Osteoporosis ◽  
Iatrogenic Cushing’S Syndrome

Background: Cushing’s syndrome is caused by excessive activation of glucocorticoid receptor. Iatrogenic Cushing syndrome is the prevalent one world -wide .Patients with Cushing’s syndrome has a high prevalence of osteoporosis. Objective: To see the prevalence of osteoporosis in Iatrogenic Cushing’s syndrome patient. Method: This descriptive cross-sectional study included 211 diagnosed case of Cushing’s syndrome during the time period of December 2013 to December 2018 in outpatient department of Dhaka Medical College and Health and Hope Hospital. Final diagnosis was done on the basis of clinical feature, serum basal cortical level and BMD. We found male were prevalent one (56%).80.56% showed biochemical evidence of Cushing’s syndrome. BMD was done in 113 patients compared with a reference population by means of T score, 17.69% patient in osteoporotic range. Conclusion: The prevalence of osteoporosis and osteopenia is age and sex independent. Judicial use of steroid and co administration with calcium, bisphosphonate can prevent osteoporosis. Treatment with bisphosphonates should be considered in all patients (irrespective of age) with Cushing’s syndrome with a low BMD to reduce fracture. Bangladesh J Medicine Jan 2020; 31(1) : 18-21

scholarly journals Analisis Profil dan Faktor-Faktor yang Memengaruhi Perilaku Kepatuhan Pengobatan untuk Pasien Diabetes Mellitus Lanjut Usia

2019 ◽  
pp. 114-125
Author(s):  
Andi Makkulawu ◽  
Adji Prayitno Setiadi ◽  
Tri Budi Wahyuni Rahardjo ◽  
Eko Setiawan
Keyword(s):  
Diabetes Mellitus ◽  
Support Groups ◽  
Health Workers ◽  
Profile Analysis ◽  
Cross Sectional Study ◽  
Diabetic Patients ◽  
Contributing Factors ◽  
Related Factors ◽  
Cross Sectional ◽  
Adherence Behaviour

Adherence with medication is one of the important factors in controlling blood glucose levels in patients with diabetes mellitus (DM), which in turn also determines the risk of diabetic complications. The profile and factors that influence adherence behaviour in the use of medication in elderly diabetic patients in Indonesia, especially in East Surabaya, are not yet known. The purpose of this study was to identify profiles and factors that influence the behavior of drug use adherence in elderly DM patients. A cross-sectional study was conducted in 32 Karang Werda or support groups for elderly in East Surabaya. Identification of the respondent’s level of adherence was carried out using the Adherence to Refill and Medication Scale (ARMS) questionnaire while the contributing factors towards adherence behaviour were identified using a published questionnaire. Both questionnaires have been validated in elderly people living in Surabaya. Result of adherence profile analysis was expressed in terms of percentage while determinant factors analysis was identified by using the highest mean among 14 sub-domains included in the questionnaire. In total, 281 elderly diabetic patients were recruited in this study. It was identified that 67.26% of the respondents were classified as non-adherence patients. The dominant factors that contribute to the behavior of medication adherence in elderly diabetic patients were social support, product-related factors, health workers, and emotional factors. Appropriate interventions to optimize the use of medications in elderly diabetic patients need to be identified and implemented according to the identified contributing factors.

scholarly journals RECOGNIZING ENDOGENOUS CUSHING’S SYNDROME AFTER THERAPY FOR SCLERODERMA

2016 ◽  
Vol 63 (4) ◽  
pp. 334-337
Author(s):  
Ana Valea ◽  
◽  
Dan Nicolae Paduraru ◽  
Adriana Elena Nica ◽  
Maria Iuliana Oprisor ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Adrenal Tumor ◽  
White Blood Cells ◽  
Serum Cortisol ◽  
Cushing's Syndrome ◽  
Serum Cortisol Level ◽  
Adrenal Crisis ◽  
Metabolic Disturbances ◽  
Threatening Condition ◽  
The Moment

Introduction. Scleroderma induces heterogeneous skin changes due to collagen anomalies, including facial. The recommended therapy is, among others, topic cortisol derived products, so an issue of diagnosis differential regarding the etiological type of Cushing’s syndrome (CS) is raised if a patient develops a suggestive phenotype. Case presentation. This is a 64-year female presenting (since the last few months) red face, high blood pressure, central obesity. She has a 6-year history of scleroderma, intermittently treated with local corticotherapy. On admission, she associated metabolic disturbances as lipid profile anomalies, high uric acid, insulin resistance and increased number of white blood cells (which were not connected with a relapse of scleroderma, neither to an inflammatory syndrome). Low baseline plasma ACTH and morning serum cortisol level (not high, yet detectable) with abnormal diurnal rhythm suggested an adrenal source of CS. A 3 cm right adrenal tumor was found on computer tomography and later removed through a classical intervention. Two weeks after, the patient voluntarily reduced her prednisone dose causing an adrenal crisis which required re-admission as an emergency. After discharge, daily oral adrenal replacement therapy is needed for the moment. Conclusions. Scleroderma, especially with skin involvement, and some of associated therapies may mask an endogenous CS as adrenal tumor derivate, thus delaying the adequate diagnosis and therapy. Patient’s education regarding a potential life threatening condition as chronic adrenal insufficiency is necessary since post-operatory recovery of adrenal function is expected within 6 to 24 months.

scholarly journals Triple negative breast cancer with ACTH-dependent Cushing's syndrome - case report

2019 ◽  
Vol 91 (2) ◽  
pp. 45-47
Author(s):  
Diana Hodorowicz-Zaniewska ◽  
Karolina Brzuszkiewicz ◽  
Joanna Szpor
Keyword(s):  
Breast Cancer ◽  
Cushing’S Syndrome ◽  
Invasive Breast Cancer ◽  
Diagnostic Tests ◽  
Metabolic Disorders ◽  
Triple Negative ◽  
Cushing's Syndrome ◽  
Malignant Tumours ◽  
Metabolic Disturbances ◽  
Ectopic Production

Introduction: Endocrine and metabolic paraneoplastic syndromes in the course of malignant tumours result from ectopic production of hormones or hormone precursors in tumour cells. Production of hormones by endocrine tumours is relatively frequent, while such production by adenocarcinoma cells is definitely rare. The study presents a case of triple negative invasive breast cancer, with ectopic secretion of ACTH (Adrenocorticotropic hormone), which provokes serious metabolic disorders. Materials and methods: The patient was admitted to hospital with symptoms of Cushing`s syndrome. Diagnostic tests revealed that a cause of metabolic disorders was breast cancer. After proper preparation the patient was qualified for surgery. Results: After mastectomy the patient’s metabolism stabilised. The patient underwent adjuvant chemotherapy and radiotheraphy. 4 months after the last cycle of systemic treatment, cancer dissemination was found. The patient was treated with second-line chemotherapy, however control CT revealed progression. The patient died 20 months after surgery and two months after the last cycle of chemotherapy. Conclusions: The case reported in this study – triple negative invasive breast cancer, responsible for ectopic production of ACTH and causing Cushing’s syndrome – is a rare phenomenon. Treatment of patients with breast cancer showing hormonal activity should not differ from general rules applied for breast cancer. However due to accompanying metabolic disturbances, the patients need individualised oncological approach, precise diagnostic tests and adequate preoperative preparation.

scholarly journals Improvement but no normalization of quality of life and cognitive functioning after treatment for Cushing’s syndrome

2019 ◽  
Author(s):  
Leonie H A Broersen ◽  
Cornelie D Andela ◽  
Olaf M Dekkers ◽  
Alberto M Pereira ◽  
Nienke R Biermasz
Keyword(s):  
Quality Of Life ◽  
Cognitive Functioning ◽  
Cushing’S Syndrome ◽  
Meta Analysis ◽  
Cushing's Syndrome ◽  
Treatment Quality ◽  
Cross Sectional ◽  
Effective Interventions ◽  
Before And After

Abstract Background Cushing’s syndrome is characterized by glucocorticoid excess, which induces physical and mental symptoms, impairments in functional status and perceived health, resulting in impaired quality of life. Biochemical remission is urgently required; however, quality of life and cognitive function may remain impaired. Objective To perform a systematic review and meta-analysis evaluating changes in health-related quality of life and cognitive functioning in patients with Cushing’s syndrome after treatment. Methods Eight electronic databases were searched in March 2017, and PubMed again in May 2018, to identify potentially relevant articles. Eligible studies were (randomized controlled) trials, cohort studies, and cross-sectional studies assessing quality of life or cognitive functioning in patients treated for Cushing’s syndrome. Differences were expressed as standardized mean difference, and reported with 95% confidence intervals. We compared patients before and after treatment (improvement), and patients after treatment and healthy controls (normalization). Results We included 47 articles with 2,643 patients. Most patients had Cushing’s disease and were in remission after treatment. Quality of life and cognitive functioning improved after treatment in all studied domains. Compared to a healthy control population, quality of life did not normalize. Cognitive functioning normalized in part, but not all, of the studied domains. Conclusions Treatment of Cushing’s syndrome improves quality of life and cognitive functioning. As normalization was not achieved in quality of life and in some aspects of cognitive functioning, special and continuous attention should be given to these aspects for patients after treatment. Effective interventions for further improvement and possibly normalization are urgently needed.

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