Five cases of cyclical Cushing's syndrome.

Atkinson, A. B.; Kennedy, Allan Laurence; Carson, David; Hadden, D. R.; Weaver, J. A.; Sheridan, B.

doi:10.1136/bmj.291.6507.1453

Cited by 111 publications

(61 citation statements)

References 25 publications

(1 reference statement)

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“…Theirs was the first accurate description of the apparently paradoxical response to dexamethasone being a purely fortuitous circumstance in a patient with a spontaneously rhythmic steroid production controlled by a mechanism not susceptible to the negative feedback action of steroids. These findings were confirmed and expanded by Atkinson et al (46,47), who described a patient with cyclic CS due to a pituitary adenoma whose cortisol secretion followed two different rhythms, i.e. a 40-day period of cortisol excess was followed by 60-70 days of normal cortisol secretion; during the period of excess of cortisol production, cortisol secretion peaked every 3-6 days, with intervening troughs of normal cortisol levels.…”

Section: Why Can Periodic Cortisol Production Complicate the Diagnosisupporting

confidence: 65%

Cyclic Cushing's Syndrome: An Overview

2004

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Section: Why Can Periodic Cortisol Production Complicate the Diagnosisupporting

confidence: 65%

Cyclic Cushing's Syndrome: An Overview

2004

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“…Streeten and co-workers determined the frequency of intermittent hypercortisolism in 31 patients with Cushing's disease after transsphenoidal surgical procedures, and demonstrated intermittent hypercortisolism in six subjects (19%) (18). Atkinson et al followed 14 patients with CS during 2 years by frequent cortisol measurements and documented cyclic hormonogenesis in five patients (36%) (19). These data suggest that cyclic cortisol production is present in about 20-40% of patients with CS, which might only be detected by careful investigation of the cortisol secretion pattern.…”

Section: Prevalencementioning

confidence: 99%

Cyclic Cushing’s syndrome: a clinical challenge

Meinardi¹,

Wolffenbuttel²,

Dullaart³

2007

eur j endocrinol

125

134

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Cyclic Cushing's syndrome (CS) is a rare disorder, characterized by repeated episodes of cortisol excess interspersed by periods of normal cortisol secretion. The so-called cycles of hypercortisolism can occur regularly or irregularly with intercyclic phases ranging from days to years. To formally diagnose cyclic CS, three peaks and two troughs of cortisol production should be demonstrated. Our review of 65 reported cases demonstrates that cyclic CS originates in 54% of cases from a pituitary corticotroph adenoma, in 26% from an ectopic ACTH-producing tumour and in about 11% from an adrenal tumour, the remainder being unclassified. The pathophysiology of cyclic CS is largely unknown. The majority of patients with cyclic CS have clinical signs of CS, which can be either fluctuating or permanent. In a minority of patients, clinical signs of CS are absent. The fluctuating clinical picture and discrepant biochemical findings make cyclic CS extremely hard to diagnose. Clinicians should therefore be aware of this clinical entity and actively search for it in all patients with suspected CS but normal biochemistry or vice versa. Frequent measurements of urinary cortisol or salivary cortisol levels are a reliable and convenient screening tool for suspected cyclic CS. Cortisol stimulation or suppression tests may give spurious results owing to spontaneous falls or rises in serum cortisol at the time of testing. When cyclic CS is biochemically confirmed, further imaging and laboratory studies are guided by the presence or absence of ACTH dependency. In cases of suspected ectopic ACTH production, specific biochemical testing for carcinoids or neuroendocrine tumours is required, including measurements of serotonin in platelets and/or urine, chromogranin A and calcitonin.European Journal of Endocrinology 157 245-254

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“…Nevertheless, as summarised in Table 3, a number of studies on the diagnostic performance of late-night salivary cortisol measurements for diagnosing Cushing's syndrome by commercially available immunoassays have demonstrated a useful contribution of these methods. False-negative results, however, must be expected; these may in particular be due to cases of Cushing's Bereitgestellt von | Universitaetsbibliothek der LMU Muenchen Angemeldet | 129.187.254.47 Heruntergeladen am | 18.11.13 11:12 syndrome with inconsistent hormone secretion (18). Consequently, repeated sampling should be considered to increase diagnostic sensitivity (7).…”

Section: Bereitgestellt Von | Universitaetsbibliothek Der Lmu Muenchenmentioning

confidence: 99%

Measurement of late-night salivary cortisol with an automated immunoassay system

Vogeser¹,

Durner²,

Seliger³

et al. 2006

Clinical Chemistry and Laboratory Medicine (CCLM)

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Background: Measurement of late-night salivary cortisol concentrations is increasingly used as a screening test in suspected Cushing's syndrome. Cortisol concentrations are typically extremely low in latenight samples and discordant assay-specific reference ranges have been reported. Therefore, the aim of our study was to assess the analytical performance of the first automated cortisol immunoassay specified for salivary measurements and to establish late-night sampling reference-range data for this test. Methods: Salivary cortisol was measured using the Roche Cobas Cortisol assay (Roche Diagnostics). Five salivary pools in different concentration ranges were used to assess the inter-assay imprecision of this test in a two-centre evaluation protocol including two reagent lots. Linearity was tested by serial dilution. Salivary samples were obtained at 23:00 h from 100 apparently healthy volunteers using a commercially available salivary sampling device (Salivette, Sarstedt). A subset of 20 samples was used for method comparison with isotope dilution liquid chromatography-tandem mass spectrometry. Results: Inter-assay coefficients of variation (ns20) between 11.6% and 40.4% were found for mean cortisol concentrations between 12.9 and 2.6 nmol/L, with an estimated functional sensitivity of approximately 5.0 nmol/L. The test also gave linear results in the lowest concentration range between 1.0 and 8.3 nmol/L. Mean late-night salivary cortisol of 5.0 nmol/L was found for healthy individuals; the absolute range was 1.4-16.7 nmol/L, and the 95th percentile was 8.9 nmol/L. Substantially lower concentrations were found with isotope dilution LC-MS/MS compared to immunoassay results (mean concentrations 1.8 and 4.4 nmol/L, respectively). Conclusions: The automated assay investigated was found to offer acceptable analytical performance in the very low concentration range required for latenight salivary cortisol, despite a very short turnaround time. Using this assay, late-night salivary

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Five cases of cyclical Cushing's syndrome.

Abstract: Reported cases of cyclical Cushing

Cited by 111 publications

References 25 publications

Cyclic Cushing's Syndrome: An Overview

Cyclic Cushing's Syndrome: An Overview

Cyclic Cushing’s syndrome: a clinical challenge

Measurement of late-night salivary cortisol with an automated immunoassay system

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