Recovery of the hypothalamo-pituitary adrenal axis following successful surgical treatment in various forms of Cushing's syndrome

2014 ◽  
Author(s):  
Sotiria Palimeri ◽  
Marinella Tzanela ◽  
Athina Assimakopoulou ◽  
Stlylianos Tsagarakis
Keyword(s):  
Surgical Treatment ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Adrenal Axis ◽  
Pituitary Adrenal Axis

Treatment of iatrogenic Cushing’s syndrome: questions of glucocorticoid withdrawal

2007 ◽  
Vol 148 (5) ◽  
pp. 195-202 ◽  
Author(s):  
Péter Igaz ◽  
Károly >Rácz ◽  
Miklós Tóth ◽  
Edit Gláz ◽  
Zsolt Tulassay
Keyword(s):  
Cushing’S Syndrome ◽  
Underlying Disease ◽  
Cushing's Syndrome ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Laboratory Examinations ◽  
High Doses ◽  
Pituitary Adrenal Axis ◽  
Iatrogenic Cushing’S Syndrome

Iatrogenic Cushing’s syndrome is the most common form of hypercortisolism. Glucocorticoids are widely used for the treatment of various diseases, often in high doses that may lead to the development of severe hypercortisolism. Iatrogenic hypercortisolism is unique, as the application of exogenous glucocorticoids leads to the simultaneous presence of symptoms specific for hypercortisolism and the suppression of the endogenous hypothalamic-pituitary-adrenal axis. The principal question of its therapy is related to the problem of glucocorticoid withdrawal. There is considerable interindividual variability in the suppression and recovery of the hypothalamic-pituitary-adrenal axis, therefore, glucocorticoid withdrawal and substitution can only be conducted in a stepwise manner with careful clinical follow-up and regular laboratory examinations regarding endogenous hypothalamic-pituitary-adrenal axis activity. Three major complications which can be associated with glucocorticoid withdrawal are: i. reactivation of the underlying disease, ii. secondary adrenal insufficiency, iii. steroid withdrawal syndrome. Here, the authors summarize the most important aspects of this area based on their clinical experience and the available literature data.

A study of hypothalamic-pituitary-adrenal suppression following curative surgery for Cushing's syndrome due to adrenal adenoma

1987 ◽  
Vol 114 (2) ◽  
pp. 166-170 ◽  
Author(s):  
D. Gordon ◽  
C. G. Semple ◽  
G. H. Beastall ◽  
J. A. Thomson
Keyword(s):  
Cushing’S Syndrome ◽  
Adrenal Adenoma ◽  
Cushing's Syndrome ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Curative Surgery ◽  
Unilateral Adrenalectomy ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Cortisol Responses ◽  
Pituitary Adrenal Axis

Abstract. The hypothalamic-pituitary-adrenal axis was investigated in all six patients requiring glucocorticoid replacement 2.5–11 years after unilateral adrenalectomy for adrenal adenomas causing Cushing's syndrome. The hypothalamic-pituitary-adrenal axis was assessed by insulin induced hypoglycaemia and CRF testing in each patient. Two patients showed normal cortisol and ACTH responses to hypoglycaemia. Two patients showed subnormal cortisol responses to hypoglycaemia in the presence of high or normal basal ACTH concentrations. ACTH concentrations increased with both hypoglycaemia and CRF. Two patients showed subnormal cortisol responses to hypoglycaemia and CRF. One of these patients showed an ACTH rise following hypoglycaemia but not CRF. Defects at either hypothalamic-pituitary or adrenal levels were demonstrated and recovery of the axis appears to commence at the hypothalamic-pituitary level.

scholarly journals OPHTHALMIC STEROIDS, CUSHING'S SYNDROME AND PERSISTENT SUPPRESSION OF THE PITUITARY-ADRENAL AXIS

1974 ◽  
Vol 8 (4) ◽  
pp. 377-377
Author(s):  
Herbert L Vallet ◽  
Edward V Rafuse ◽  
Kathleen A Poon ◽  
Eleanor Grimm ◽  
Lesley S Baldwin ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Adrenal Axis ◽  
Pituitary Adrenal Axis

Cushing's Syndrome and Hypothalamic-Pituitary Adrenal Axis Suppression Induced by Medroxyprogesterone Acetate

1996 ◽  
Vol 33 (3) ◽  
pp. 187-189 ◽  
Author(s):  
K J Malik ◽  
K Wakelin ◽  
S Dean ◽  
D H Cove ◽  
P J Wood
Keyword(s):  
Cushing’S Syndrome ◽  
Medroxyprogesterone Acetate ◽  
Plasma Cortisol ◽  
Cushing's Syndrome ◽  
Adrenocorticotrophic Hormone ◽  
Adrenal Axis ◽  
Synacthen Test ◽  
Cortisol Responses ◽  
Short Synacthen Test ◽  
Pituitary Adrenal Axis

The referral of a patient with features of Cushing's syndrome but with suppressed plasma cortisol and adrenocorticotrophic hormone concentrations prompted us to study the effect of medroxyprogesterone acetate (MPA) therapy on the adrenal axis. 11 women (aged 54–82 years) who were receiving 200–400 mg/day MPA were studied. Of these, four had subnormal plasma cortisol responses to a short synacthen test, and two more had borderline responses (30 min post-synacthen plasma cortisol results of 411 and 511 nmol/L). We conclude that suppression of the adrenal axis occurs relatively frequently in patients on MPA and that such patients should be checked for evidence of suppression before MPA therapy is withdrawn.

Immune regulation in cushing's syndrome: Relationship to hypothalamic-pituitary-adrenal axis hormones

1996 ◽  
Vol 21 (7) ◽  
pp. 599-608 ◽  
Author(s):  
Ziad Kronfol ◽  
Monica Starkman ◽  
David E. Schteingart ◽  
Vijendra Singh ◽  
Qun Zhang ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Immune Regulation ◽  
Cushing's Syndrome ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Pituitary Adrenal Axis

Schizophrenia and Cushing's syndrome cured by adrenalectomy

1975 ◽  
Vol 5 (2) ◽  
pp. 165-168 ◽  
Author(s):  
John Johnson
Keyword(s):  
Insulin Therapy ◽  
Cushing’S Syndrome ◽  
Mental Hospital ◽  
Cushing's Syndrome ◽  
Schizophrenic Psychosis ◽  
Endocrine Disorder ◽  
Adrenal Axis ◽  
Pituitary Adrenal Axis

SynopsisA case of Cushing's syndrome in a woman aged 50 years is described, with psychosis of schizophrenic type. The psychosis and endocrine disorder were subsequently cured by adrenalectomy. Twenty-five years previously the patient had a typical schizophrenic psychosis treated in mental hospital with deep insulin therapy and ECT. The possibility is raised that deep insulin therapy could have induced the Cushing's syndrome through its non-specific stressor effect on the pituitary-adrenal axis.

CUSHING'S SYNDROME IN INFANCY

PEDIATRICS ◽  
1970 ◽  
Vol 46 (2) ◽  
pp. 217-229
Author(s):  
Michel G. Gilbert ◽  
William W. Cleveland
Keyword(s):  
Surgical Treatment ◽  
Cushing’S Syndrome ◽  
Adrenal Tumor ◽  
Cushing's Syndrome ◽  
Adrenal Steroids ◽  
Careful Attention ◽  
Intravenous Pyelogram ◽  
Reasonable Expectation ◽  
Surgical Cure ◽  
Postoperative Administration

Cushing's syndrome in infancy is usually due to adrenal tumor which is often malignant. Three cases are described in which the disorder was due to adenoma and surgical cure was achieved. The clinical picture is strongly suggestive if not diagnostic. Its hallmark is generalized obesity with typical facies; also present are hypertension and signs of virilization. Striae were not found in our patients. Increased excretion of both 17-hydroxysteroids and 17-ketosteroids is characteristic; this excretion was not suppressed by dexamethasone in two of these patients in whom it was tested. Intravenous pyelogram was distinctly abnormal in all cases and indicated the presence and location of the tumor. The diagnosis can be made efficiently and surgical treatment can be promptly instituted with reasonable expectation of cure. Careful attention must be paid to preoperative and postoperative administration of adrenal steroids.

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