Muscle strength in Cushing's syndrome: cross-sectional evaluation of the German Cushing's registry

2016 ◽  
Author(s):  
Christina M Berr ◽  
Marcus Quinkler ◽  
Mareike Stieg ◽  
Timo Deutschbein ◽  
Andrea Osswald ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Cross Sectional

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 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.

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 Support Needs of Patients with Cushing’s Disease and Cushing’s Syndrome: Results of a Survey Conducted in Germany and the USA

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Ilonka Kreitschmann-Andermahr ◽  
Sonja Siegel ◽  
Christa Gammel ◽  
Karen Campbell ◽  
Leslie Edwin ◽  
...  
Keyword(s):  
Medical Care ◽  
Cushing’S Syndrome ◽  
Cushing’S Disease ◽  
Disease Burden ◽  
Cushing's Syndrome ◽  
Cushing's Disease ◽  
Support Needs ◽  
Cross Sectional ◽  
Patient Support Group

Background. Cushing’s disease (CD) and Cushing’s syndrome (CS) are chronic illnesses, characterized by symptoms of prolonged hypercortisolism, which often changes to hypocortisolism after successful treatment. In view of the high disease burden of CD/CS patients and long-term impaired quality of life, the present survey was conducted to gain information about subjective illness distress and patients’ specific needs in terms of supportive measures beyond medical interventions. Patients and Methods. Cross-sectional questionnaire study including patients with CD treated in 2 German neurosurgical tertiary referral centers and CD/CS patient members of a US-based patient support group completed a survey inquiring about disease burden, coping strategies, and support needs. Additionally, the degree of interest in different offers, e.g., internet-based programs and seminars, was assessed. Results. 84 US and 71 German patients answered the questionnaire. Patients in both countries indicated to suffer from Cushing-related symptoms, reduced performance, and psychological problems. 48.8% US patients and 44.4% German patients stated that good medical care and competent doctors helped them the most in coping with the illness. US patients were more interested in support groups (p=0.035) and in courses on illness coping (p=0.008) than the German patients, who stated to prefer brochures (p=0.001). 89.3% of US patients would attend internet-based programs compared to 75.4% of German patients (p=0.040). There were no differences between groups for the preferred duration of and the willingness to pay for such a program, but US patients would travel longer distances to attend a support meeting (p=0.027). Conclusion. Patients in both countries need skilled physicians and long-term medical care in dealing with the effects of CD/CS, whereas other support needs differ between patients of both countries. The latter implies that not only disease-specific but also culture-specific training programs would need to be considered to satisfy the needs of patients in different countries.

Respiratory Muscle Strength in Cushing's Syndrome

1999 ◽  
Vol 160 (5) ◽  
pp. 1762-1765 ◽  
Author(s):  
GARY H. MILLS ◽  
DIMITRIS KYROUSSIS ◽  
PAUL JENKINS ◽  
CARL-HUGO HAMNEGARD ◽  
MICHAEL I. POLKEY ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Cushing’S Syndrome ◽  
Respiratory Muscle ◽  
Cushing's Syndrome ◽  
Respiratory Muscle Strength

scholarly journals A direct comparison of quality of life in obese and Cushing's syndrome patients

2013 ◽  
Vol 168 (5) ◽  
pp. 787-793 ◽  
Author(s):  
Smita Baid Abraham ◽  
Brent S Abel ◽  
Domenica Rubino ◽  
Tonja Nansel ◽  
Sheila Ramsey ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cushing’S Syndrome ◽  
Cross Sectional Study ◽  
Cushing's Syndrome ◽  
Cross Sectional ◽  
Clinical Center ◽  
Sf 36 ◽  
Related Quality ◽  
Health Related

ObjectiveObese (OB) individuals and patients with Cushing's syndrome (CS) often have similar clinical presentations. While each group has reduced health-related quality of life (HRQL), it is not known whether the degree of impairment is different and might distinguish between them. The objective of this study was to compare HRQL in these two populations.DesignCross-sectional study.MethodsThree hundred and twenty-seven OB patients (48.1±11.7 years; 72.5% women) with weight gain and at least two features of CS were recruited from an outpatient weight management clinic. Sixty-six untreated patients with CS (41.6±13.2 years; 78.8% women) presented to the NIH Clinical Center for evaluation. Subjects completed the SF-36 survey and a locally created symptom questionnaire.ResultsAfter adjusting for symptom count, OB patients had a significantly higher (better HRQL) mean physical component summary (PCS) score than CS patients (44.9±0.6 vs 35.4±1.5, P<0.0001). However, the mean mental component summary (MCS) score was lower (worse HRQL) in the OB group (41.6±0.6 vs 50.7±1.6, P<0.0001). Symptom count showed significant correlations with PCS and MCS scores. BMI correlated with PCS (r=−0.29) in OB but not in CS patients. BMI was not associated with MCS in either group.ConclusionHRQL is significantly different between OB and CS patients. Surprisingly, after adjusting for symptom count, OB patients showed worse mental health scores than the CS population. Significant differences in HRQL and symptom count may suggest which OB patients should be screened for CS.

scholarly journals Association between Neutrophilic Granulocyte Percentage and Diabetes Mellitus in Cushing’s Syndrome Patients: A Cross-Sectional Study

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Baomin Wang ◽  
Yumei Yang ◽  
Haoyue Yuan ◽  
Xiaomu Li
Keyword(s):  
Diabetes Mellitus ◽  
Blood Cell ◽  
Cushing’S Syndrome ◽  
Cross Sectional Study ◽  
Cushing's Syndrome ◽  
Sectional Study ◽  
Cross Sectional ◽  
Neutrophilic Granulocyte ◽  
Cell Parameters ◽  
Significant Independent Risk Factor

Background. Glucose metabolism is frequently impaired in patients with Cushing’s syndrome (CS) due to chronic exposure to excess glucocorticoids. Inflammation plays an essential role in the pathophysiology of diabetes mellitus (DM). The present study aimed to investigate the potential associations of inflammatory blood cell parameters, including white blood cell (WBC) count, neutrophil count, neutrophilic granulocyte percentage (NEUT%), lymphocyte count (LYM), and lymphocyte proportion (LYM%), with diabetes mellitus in Cushing's syndrome patients. Materials and Methods. The cross-sectional study was conducted in Zhongshan Hospital of Fudan University, China. A total of 150 patients with Cushing’s syndrome were retrospectively screened from 2017 to 2019. The demographic data, clinical data, and blood samples (lipids, adrenal, glucose, and inflammatory blood cell parameters) were recorded. Statistical analyses were carried out by using the SPSS software package, version 13.0. Results. In this study, the prevalence of diabetes mellitus was 38.7% in patients with Cushing’s syndrome. Patients with DM had higher WBC, neutrophil, NEUT% levels than patients without DM ( p < 0.05 ). As the NEUT% increased, a stepwise increase in glucose and glycated hemoglobin (HbA1c) level was observed. In addition, in the multivariate logistic regression, NEUT% was a significant independent risk factor for DM, regardless of gender, age, body mass index (BMI), and triglyceride and 12 midnight cortisol (12 MN cortisol) level (OR = 2.542, 95% CI 1.337–4.835, p < 0.001 ). Conclusions. In conclusion, elevated NEUT% level was linked to diabetes in patients with Cushing’s syndrome. The neutrophilic granulocyte percentage may be referred to as a new predictor for diabetes in Cushing’s syndrome patients.

scholarly journals SAT-146 A Rare Combination of Severe Ectopic Cushing’s Syndrome and Graves Hyperthyroidism: A Case Report

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Janelle Violago ◽  
Farhad Hasan
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Intracranial Extension ◽  
Graves Disease ◽  
Hormone Production ◽  
Cross Sectional ◽  
Ectopic Acth ◽  
Ectopic Acth Secretion ◽  
Late Night ◽  
Hypokalemic Alkalosis

Abstract BACKGROUND: Ectopic ACTH secretion (EAS) is a rare cause of Cushing’s syndrome. Olfactory neuroblastoma (ONB) is a malignant tumor derived from the olfactory epithelium and can rarely be a source of ectopic hormone production. There are only 19 reported cases of EAS from ONB. We report a case of severe ectopic Cushing’s due to ONB. Interestingly, the patient also presented with Graves disease, which is an unusual pathophysiologic combination since supraphysiologic levels of glucocorticoids suppress the immune system, thereby ameliorating autoimmune processes. Remarkably, Graves disease improved following the removal of the source of ectopic ACTH. CASE PRESENTATION: A 41year old male presented with epistaxis, anosmia, and headaches. He also reported recent weight gain, muscle weakness, and new onset hypertension. Cross-sectional imaging revealed a right nasal cavity mass with intracranial extension. Endonasal biopsy was consistent with a diagnosis of ONB. Biochemical evaluation demonstrated hypokalemic alkalosis, hyperglycemia, and severe hypercortisolism [ACTH 734 (9-46 pg/ml), am cortisol 110 (2-15 ug/ml), late night salivary cortisol 9.8 and 22.53 (&lt;0.09 ug/dl), 24 hour UFC 41,337.3 (4-50 mcg) and non-suppressed cortisol 110 (1.8 mcg/dl) by 1 mg dexamethasone]. Pituitary MRI showed no sellar pathology. Following a period of cortisol suppression with Ketoconazole then with Etomidate infusion, the patient underwent resection of the ONB, followed by chemo- and radiotherapy, which resulted in improvement of severe hypercortisolism. Histopathology showed positive ACTH immunostaining. Pre-operative evaluation also demonstrated hyperthyroidism: TSH &lt;0.010 (0.3-5uIu/ml), FT4 3.11 (0.89-1.76 ng/dl), normal TT3 0.81 (0.6-1.81 ng/ml). Thyroid auto-antibodies were negative; however, radioiodine scan and uptake demonstrated diffusely increased uptake in the enlarged thyroid gland. Pre-operative euthyroidism was achieved with a combination of methimazole, SSKI and cholestyramine. After 6 months of methimazole therapy the patient presented with hypothyroidism (TSH 72.37, FT4 0.1). Methimazole was discontinued and he achieved euthyroidism on subsequent evaluations. CONCLUSION: EAS due to ONB is a very rare cause of Cushing’s syndrome. To our knowledge, this is the first reported case of a male presenting with EAS and concurrent Graves hyperthyroidism. An extensive review of the literature and seeking expert opinion did not provide a convincing pathophysiologic explanation to this unusual concurrence. We therefore hypothesize that, while the two endocrine conditions were simultaneous, they were likely unrelated.

scholarly journals Mental Fatigue and Executive Dysfunction in Patients with Cushing’s Syndrome in Remission

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Eleni Papakokkinou ◽  
Birgitta Johansson ◽  
Peter Berglund ◽  
Oskar Ragnarsson
Keyword(s):  
Cushing’S Syndrome ◽  
Executive Dysfunction ◽  
Cross Sectional Study ◽  
Cushing's Syndrome ◽  
Mental Fatigue ◽  
Cross Sectional ◽  
Part D ◽  
Trail Making ◽  
Impaired Quality

Patients with Cushing’s syndrome (CS) in remission often suffer from impaired quality of life and cognitive dysfunction. The primary aim was to investigate the occurrence of mental fatigue, characterized by mental exhaustion and long recovery time following mentally strenuous tasks, in patients with CS in remission. The secondary aim was to examine whether the newly developed parts C and D of the trail making test (TMT) are more sensitive, compared to the conventional parts A and B, to evaluate attention and executive function. This was a cross-sectional study including 51 patients with CS in remission and 51 controls. All subjects completed the self-administrated mental fatigue scale (MFS) and performed all four parts of the TMT. The patients had worse outcome on all components of the MFS except for sensitivity to noise. After adjustment for mental fatigue, depression, and anxiety, the patients performed worse only on part D of the TMT (P<0.05). Mental fatigue is common in patients with CS in remission and can be captured by using the MFS. The most demanding part of the TMT, part D, is more useful to capture cognitive deficits in patients with CS in remission compared to the conventional parts A and B.

scholarly journals Persisting Muscle Dysfunction in Cushing’s Syndrome Despite Biochemical Remission

2020 ◽  
Vol 105 (12) ◽  
pp. e4490-e4498 ◽  
Author(s):  
Frederick Vogel ◽  
Leah T Braun ◽  
German Rubinstein ◽  
Stephanie Zopp ◽  
Heike Künzel ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Grip Strength ◽  
Cushing’S Syndrome ◽  
Muscle Function ◽  
Tertiary Care ◽  
Cushing's Syndrome ◽  
Muscle Dysfunction ◽  
Long Term Outcome

Abstract Context Glucocorticoid-induced myopathy is a characteristic symptom of endogenous Cushing’s syndrome (CS). Its long-term outcome is largely unknown. Objective To evaluate long-term muscle function following the remission of endogenous CS. Study Design Observational longitudinal cohort study. Setting Tertiary care hospitals and a specialized outpatient clinic. Patients As part of the prospective multicenter German Cushing’s Registry, we assessed muscle strength in patients with overt endogenous CS. We studied the patients at the time of diagnosis (n = 88), after 6 months (n = 69), and thereafter annually, following surgical remission over a period of up to 4 years (1 year: n = 55; 2 years: n = 34; 3 years: n = 29; 4 years: n = 22). Muscle function was evaluated by hand grip strength and by chair rising test. Results Grip strength was decreased to 83% of normal controls (100%) at the time of diagnosis. It further decreased to 71% after 6 months in remission (P ≤ 0.001) and showed no improvement during further follow-up compared with baseline. Chair rising test performance improved initially (8 seconds at baseline vs 7 seconds after 6 months, P = 0.004) but remained at this reduced level thereafter (7 seconds after 3 years vs 5 seconds in controls, P = 0.038). In multivariate analysis, we identified, as predictors for long-term muscle dysfunction, age, waist-to-hip ratio, and hemoglobin A1c at baseline. Furthermore, muscle strength during follow-up was strongly correlated with quality of life. Conclusion This study shows that CS-associated myopathy does not spontaneously resolve during remission. This calls for action to identify effective interventions to improve muscle dysfunction in this setting.

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