Cushing Syndrome

2019 ◽  
Author(s):  
Lynnette Nieman
Keyword(s):  
Chronic Exposure ◽  
Laboratory Tests ◽  
Adrenocorticotropic Hormone ◽  
Cushing Syndrome ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Screening Tests ◽  
Imaging Studies ◽  
Common Cause ◽  
Pituitary Adrenal Axis

Cushing syndrome is a condition with protean manifestations that are caused by chronic exposure to excess glucocorticoids. Treatment with supraphysiologic doses of glucocorticoids is the most common cause. Pathologic hypercortisolism may result from autonomous adrenal production or as a result of the action of excessive adrenocorticotropic hormone (ACTH) production by a tumor, which stimulates adrenal cortisol production. Primary adrenal forms include unilateral adenoma or carcinoma or, rarely, bilateral hyperplasia and/or nodules. This chapter covers the epidemiology, etiology, pathophysiology, and diagnosis of Cushing syndrome. Clinical manifestations, physical examination findings, and laboratory tests, including tests of the blood and other body fluids, imaging studies, and biopsy, are discussed. The differential diagnosis, treatment options, complications, and prognosis are described. Tables outline clinical features and causes of Cushing syndrome, abnormalities associated with primary adrenal causes of Cushing syndrome, diagnostic accuracy of screening tests, endogenous hypercortisolism without Cushing syndrome, and medical therapy for Cushing syndrome. Figures illustrate the causes of Cushing syndrome and a comparison of the hypothalamic-pituitary-adrenal axis in patients with ACTH-dependent Cushing syndrome and those with pseudo–Cushing syndrome. Algorithms show the evaluation of possible Cushing syndrome and evaluation of the causes of Cushing syndrome. Second-line treatments for Cushing syndrome when surgery fails or is not possible are also detailed. This chapter contains 5 figures, 7 tables, 50 references.

Cushing Syndrome

2019 ◽  
Author(s):  
Lynnette Nieman
Keyword(s):  
Chronic Exposure ◽  
Laboratory Tests ◽  
Adrenocorticotropic Hormone ◽  
Cushing Syndrome ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Screening Tests ◽  
Imaging Studies ◽  
Common Cause ◽  
Pituitary Adrenal Axis

Cushing syndrome is a condition with protean manifestations that are caused by chronic exposure to excess glucocorticoids. Treatment with supraphysiologic doses of glucocorticoids is the most common cause. Pathologic hypercortisolism may result from autonomous adrenal production or as a result of the action of excessive adrenocorticotropic hormone (ACTH) production by a tumor, which stimulates adrenal cortisol production. Primary adrenal forms include unilateral adenoma or carcinoma or, rarely, bilateral hyperplasia and/or nodules. This chapter covers the epidemiology, etiology, pathophysiology, and diagnosis of Cushing syndrome. Clinical manifestations, physical examination findings, and laboratory tests, including tests of the blood and other body fluids, imaging studies, and biopsy, are discussed. The differential diagnosis, treatment options, complications, and prognosis are described. Tables outline clinical features and causes of Cushing syndrome, abnormalities associated with primary adrenal causes of Cushing syndrome, diagnostic accuracy of screening tests, endogenous hypercortisolism without Cushing syndrome, and medical therapy for Cushing syndrome. Figures illustrate the causes of Cushing syndrome and a comparison of the hypothalamic-pituitary-adrenal axis in patients with ACTH-dependent Cushing syndrome and those with pseudo–Cushing syndrome. Algorithms show the evaluation of possible Cushing syndrome and evaluation of the causes of Cushing syndrome. Second-line treatments for Cushing syndrome when surgery fails or is not possible are also detailed. This chapter contains 5 figures, 7 tables, 50 references.

scholarly journals SUN-186 Case Report: Mifepristone Taper in an Individual with Equivocal Cushing’s Syndrome Screening Tests

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Christopher Martin ◽  
David Perez-Molinar ◽  
Tyler C Drake
Keyword(s):  
Cushing’S Syndrome ◽  
Adrenocorticotropic Hormone ◽  
Hemorrhagic Stroke ◽  
Surgical Intervention ◽  
Cushing's Syndrome ◽  
Screening Tests ◽  
Imaging Studies ◽  
Bridge Therapy ◽  
Work Up ◽  
Dexamethasone Suppression

Abstract We present a 75-year-old male evaluated by the inpatient endocrine service during an admission for hemorrhagic stroke. Approximately 1 year prior to this admission he was started on mifepristone therapy for presumed Cushing’s Syndrome. Initial Cushing’s work-up was equivocal: 1 mg dexamethasone suppression cortisol level of 1.9 and midnight salivary cortisol 167 ng/dl. Random ACTH measurement was not obtained as part of this initial evaluation. Review of prior imaging studies did not demonstrate obvious culprit pituitary nor adrenal lesions. Mifepristone induced hyperaldosteronism, thyroid dysfunction and adrenal insufficiency were demonstrated presumably secondary to cortisol receptor antagonist induced up-regulation of adrenocorticotropic hormone and cortisol. We describe our experience stopping mifepristone and performing re-evaluation. We propose a tapering protocol in the setting of potentially untreated Cushing’s Syndrome and suggest use as a bridge therapy to surgical intervention rather than destination therapy.

scholarly journals Depression in adolescence: a review

2020 ◽  
Vol 27 (1) ◽  
Author(s):  
Diogo Beirão ◽  
Helena Monte ◽  
Marta Amaral ◽  
Alice Longras ◽  
Carla Matos ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Primary Care Providers ◽  
Scientific Data ◽  
Screening Tests ◽  
Medical Community ◽  
Main Body ◽  
Care Providers

Abstract Background Depression is a common mental health disease, especially in mid to late adolescence that, due to its particularities, is a challenge and requires an effective diagnosis. Primary care providers are often the first line of contact for adolescents, being crucial in identifying and managing this pathology. Besides, several entities also recommend screening for depression on this period. Thus, the main purpose of this article is to review the scientific data regarding screening, diagnosis and management of depression in adolescence, mainly on primary care settings. Main body Comprehension of the pathogenesis of depression in adolescents is a challenging task, with both environmental and genetic factors being associated to its development. Although there are some screening tests and diagnostic criteria, its clinical manifestations are wide, making its diagnosis a huge challenge. Besides, it can be mistakenly diagnosed with other psychiatric disorders, making necessary to roll-out several differential diagnoses. Treatment options can include psychotherapy (cognitive behavioural therapy and interpersonal therapy) and/or pharmacotherapy (mainly fluoxetine), depending on severity, associated risk factors and available resources. In any case, treatment must include psychoeducation, supportive approach and family involvement. Preventive programs play an important role not only in reducing the prevalence of this condition but also in improving the health of populations. Conclusion Depression in adolescence is a relevant condition to the medical community, due to its uncertain clinical course and underdiagnosis worldwide. General practitioners can provide early identification, treatment initiation and referral to mental health specialists when necessary.

Cyclic Cushing syndrome: definitions and treatment implications

2007 ◽  
Vol 23 (3) ◽  
pp. 1-3 ◽  
Author(s):  
Dennis A. Velez ◽  
Marc R. Mayberg ◽  
William H. Ludlam
Keyword(s):  
Clinical Symptoms ◽  
Cushing Syndrome ◽  
Treatment Options ◽  
Hormone Production ◽  
Laboratory Findings ◽  
Paradoxical Response ◽  
Degree Of Certainty ◽  
Definition Of ◽  
Dexamethasone Suppression ◽  
Pituitary Adrenal Axis

✓ Endogenous Cushing syndrome (CS) results from hypercortisolemia caused by excess adrenocorticotropic hormone production in a pituitary adenoma or ectopic tumor, or by an adrenal tumor that directly produces excess cortisol. The diagnosis can usually be ascertained with a reasonable degree of certainty based on clinical and laboratory findings of hypercortisolism. There are patients, however, in whom the production of excess cortisol exhibits a cyclic or intermittent pattern, and, as a result, the clinical symptoms may be quite complex and varied. In these patients the hypothalamic-pituitary-adrenal axis may be normal between cycles, and dexamethasone suppression testing may produce a paradoxical response. In the present article, the authors provide a definition of cyclic Cushing syndrome, review the causes and its potential pathophysiological mechanisms, and discuss the treatment options based on a review of the available literature.

scholarly journals GENERAL ASPECTS OF COLON CANCER SURGERIES

2021 ◽  
Vol 1 (06) ◽  
Author(s):  
Tiberio Dias Pacheco Annicchino Baptistella
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Surgical Treatment ◽  
Systemic Chemotherapy ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Common Cause ◽  
The Third ◽  
General Aspects ◽  
Tumor Types

Colorectal cancer (CCR) is the third most common tumor in men and the second most common tumor in women, accounting for 10% of all tumor types worldwide. With an estimated 608,000 deaths each year, CCR is the fourth most common cause of cancer-related death worldwide. The clinical manifestations of colon cancer depend largely on the location of the tumor. There are some treatment options such as systemic chemotherapy and intraperitoneal chemotherapy, but they are not as effective. Surgical treatment can occur in different ways, three possible forms of surgery are presented here, as well as their associated risks. New options emerge as alternatives to improve the prognosis of the disease.

Rapid Screening Methods for Bleeding Disorders. A Three Year Survey

1964 ◽  
Vol 11 (02) ◽  
pp. 506-512 ◽  
Author(s):  
V. A Lovric ◽  
J Margolis
Keyword(s):  
Laboratory Tests ◽  
Capillary Blood ◽  
Screening Tests ◽  
Rapid Screening ◽  
Screening Methods ◽  
Bleeding Disorders ◽  
Routine Laboratory ◽  
Clotting Time ◽  
Kaolin Clotting Time ◽  
In Infants And Children

SummaryAn adaptation of “kaolin clotting time” and prothrombin time for use on haemolysed capillary blood provided simple and sensitive screening tests suitable for use in infants and children. A survey of three year’s experience shows that these are reliable routine laboratory tests for detection of latent coagulation disorders.

Using Naïve Bayes Algorithm to Estimate the Response to Drug in Lung Cancer Patients

2019 ◽  
Vol 21 (10) ◽  
pp. 734-748 ◽  
Author(s):  
Baoling Guo ◽  
Qiuxiang Zheng
Keyword(s):  
Lung Cancer ◽  
Side Effects ◽  
Cancer Patients ◽  
Drug Response ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Treatment Strategies ◽  
Cancer Resistance ◽  
Lung Cancer Patients ◽  
Bayes Algorithm

Aim and Objective: Lung cancer is a highly heterogeneous cancer, due to the significant differences in molecular levels, resulting in different clinical manifestations of lung cancer patients there is a big difference. Including disease characterization, drug response, the risk of recurrence, survival, etc. Method: Clinical patients with lung cancer do not have yet particularly effective treatment options, while patients with lung cancer resistance not only delayed the treatment cycle but also caused strong side effects. Therefore, if we can sum up the abnormalities of functional level from the molecular level, we can scientifically and effectively evaluate the patients' sensitivity to treatment and make the personalized treatment strategies to avoid the side effects caused by over-treatment and improve the prognosis. Result & Conclusion: According to the different sensitivities of lung cancer patients to drug response, this study screened out genes that were significantly associated with drug resistance. The bayes model was used to assess patient resistance.

Episodic versus Chronic Dizziness: An Analysis of Predictive Factors

2021 ◽  
pp. 000348942110254
Author(s):  
Eric J. Formeister ◽  
Ricky Chae ◽  
Emily Wong ◽  
Whitney Chiao ◽  
Lauren Pasquesi ◽  
...  
Keyword(s):  
Multivariate Regression ◽  
Treatment Options ◽  
Depression And Anxiety ◽  
Imaging Studies ◽  
Comorbid Depression ◽  
Cross Sectional ◽  
Tertiary Center ◽  
Chronic Dizziness ◽  
Associated Symptoms ◽  
History Of

Objectives: To elucidate differences in demographic and clinical characteristics between patients with episodic and chronic dizziness. Methods: A cross-sectional, observational study of 217 adults referred for dizziness at 1 tertiary center was undertaken. Subjects were split into a chronic dizziness group (>15 dizzy days per month) and an episodic dizziness group (<15 dizzy days per month). Results: 217 adults (average age, 53.7 years; 56.7% female) participated. One-third (n = 74) met criteria for chronic dizziness. Dizziness handicap inventory (DHI) scores were significantly higher in those with chronic dizziness compared to those with episodic dizziness (53.9 vs 40.7; P < .001). Comorbid depression and anxiety were more prevalent in those with chronic dizziness (44.6% and 47.3% vs 37.8% and 35.7%, respectively; P > .05). Abnormal vestibular testing and abnormal imaging studies did not differ significantly between the 2 groups. Ménière’s disease and BPPV were significantly more common among those with episodic dizziness, while the prevalence of vestibular migraine did not differ according to chronicity of symptoms. A multivariate regression that included age, sex, DHI, history of anxiety and/or depression, associated symptoms, and dizziness triggers was able to account for 15% of the variance in the chronicity of dizziness (pseudo- R2 = 0.15; P < .001). Conclusions: Those who suffer from chronic dizziness have significantly higher DHI and high comorbid rates of depression and anxiety than those with episodic dizziness. Our findings show that factors other than diagnosis alone are important in the chronification of dizziness, an observation that could help improve on multimodal treatment options for this group of patients.

scholarly journals Clinical Management of Hypertension, Inflammation and Thrombosis in Hospitalized COVID-19 Patients: Impact on Survival and Concerns

2021 ◽  
Vol 10 (5) ◽  
pp. 1073
Author(s):  
Patricia Martínez-Botía ◽  
Ángel Bernardo ◽  
Andrea Acebes-Huerta ◽  
Alberto Caro ◽  
Blanca Leoz ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Clinical Management ◽  
Cox Regression ◽  
Angiotensin Receptor Blockers ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Specific Treatment ◽  
Hospitalized Patients ◽  
Thrombosis Prophylaxis ◽  
The Impact

The most severe clinical manifestations of the Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are due to an unbalanced immune response and a pro-thrombotic hemostatic disturbance, with arterial hypertension or diabetes as acknowledged risk factors. While waiting for a specific treatment, the clinical management of hospitalized patients is still a matter of debate, and the effectiveness of treatments to manage clinical manifestations and comorbidities has been questioned. In this study, we aim to assess the impact of the clinical management of arterial hypertension, inflammation and thrombosis on the survival of COVID-19 patients. The Spanish cohorts included in this observational retrospective study are from HM Hospitales (2035 patients) and from Hospital Universitario Central de Asturias (72 patients). Kaplan Meier survival curves, Cox regression and propensity score matching analyses were employed, considering demographic variables, comorbidities and treatment arms (when opportune) as covariates. The management of arterial hypertension with angiotensin-converting enzyme 2 (ACE2) inhibitors or angiotensin receptor blockers is not detrimental, as was initially reported, and neither was the use of non-steroidal anti-inflammatory drugs (NSAIDs). On the contrary, our analysis shows that the use on itself of corticosteroids is not beneficial. Importantly, the management of COVID-19 patients with low molecular weight heparin (LMWH) as an anticoagulant significantly improves the survival of hospitalized patients. These results delineate the current treatment options under debate, supporting the effectiveness of thrombosis prophylaxis on COVID-19 patients as a first-line treatment without the need for compromising the treatment of comorbidities, while suggesting cautiousness when administering corticosteroids.

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