Short‐term Fluctuations in Plasma Cortisol in Cushing's Syndrome

Vetter, Hans; Strass, R.; Bayer, J. M.; Beckerhoff, R.; Armbruster, H.; Vetter, W

doi:10.1111/j.1365-2265.1977.tb01989.x

Cited by 19 publications

(6 citation statements)

References 8 publications

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“…The findings in respect of the other patients are also in agreement with our report save in one adenoma case, where there ap¬ pears to be a diurnal variation in the plasma cortisol concentration. Other investigators have also reported results in some cases differing from our findings (Vetter et al 1977;Olsen et al 1978). The reason for these discordant results warrants further investigation.…”

Section: Discussioncontrasting

confidence: 80%

Plasma Cortisol Profiles in Cushing's Syndrome

Yoshida

Satowa

Sato

et al. 1979

Acta Endocrinologica

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Plasma cortisol profiles were studied by the frequent sampling method in 5 patients with Cushing's disease (CD), 7 patients with Cushing's syndrome due to adrenocortical adenoma (AA), and one patient with bronchogenic carcinoma. Plasma ACTH was measured by radioimmunoassay at 10 min intervals in 2 of the subjects. In CD, there was distinct episodic secretion of cortisol and ACTH; the coefficients of variation about the mean plasma cortisol concentration ranged from 24 to 27 %; plasma ACTH ranged from zero to 455 pg/ml with a mean of 94 pg/ml. In AA, the tumour secreted cortisol at a constant rate with little fluctuation; the coefficients of variation of plasma cortisol concentration ranged from 8 to 14%; plasma concentrations of ACTH were always near zero. In the patient with bronchogenic carcinoma, the coefficient of variation of cortisol was 14 %. These results were apparent even in profiles of plasma cortisol concentrations measured over only a 6 h period. It is concluded that characteristics of plasma cortisol and ACTH secretory patterns are helpful in differentiating Cushing's syndrome of differing aetiology.

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Section: Discussioncontrasting

confidence: 80%

Plasma Cortisol Profiles in Cushing's Syndrome

Yoshida

Satowa

Sato

et al. 1979

Acta Endocrinologica

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“…The available literature is not clear on this. But this could very well be a reflection of fluctuation in cortisol secretion in patients with Cushing’s syndrome, rather than real suppression 16 18. Because microadenomas can be detected in up to 10–20% of individuals without known pituitary disease,19 a positive imaging study does not prove Cushing’s disease as we also learnt from this patient.…”

Section: Discussionmentioning

confidence: 93%

Crossing the other side of the algorithm: a challenging case of adrenal Cushing's syndrome

Antonio

Sandoval²,

Lantion-Ang³

2011

Case Reports

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The diagnosis of endogenous Cushing's syndrome and its aetiology involved documenting the hypercotisolism and then determining whether that hypercortisolism is adrenocorticotropic hormone-dependent (ACTH-dependent) or not. Hence, following the algorithm, an undetected ACTH level points to an adrenal Cushing's while a detectable or elevated ACTH level points to either a pituitary or ectopic Cushing's syndrome. The authors present a case of florid adrenal Cushing's syndrome initially presenting with a normal ACTH level, which led to the investigation for an ACTH-secreting tumour. Adding to the confusion, a MRI done showed an intrasellar focus. Knowledge of how ACTH-dependent (versus ACTH-independent) Cushing's syndrome manifests clinically, supported by results of repeat laboratory tests, led to the true diagnosis. This case illustrates that a detectable ACTH does not rule out an adrenal Cushing's syndrome nor does a positive pituitary imaging confirm Cushing's disease.

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“…Some authors suggested that the secretory pattern may help the differential diagnosis of the various aetiologies of the syndrome Tourniaire et al 1971;Vagnucci 1979;Yoshida et al 1979). Others (Sederberg-Olsen et al 1973;Vetter et al 1977;Olsen 1978) claimed that this parameter could not discriminate between pa¬ tients with pituitary-dependent or pituitaryindependent Cushing's syndrome. However, with only one exception (Vagnucci 1979), these con¬ trasting conclusions were solely based on the visual examination of the data.…”

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confidence: 97%