The diagnosis and differential diagnosis of Cushing's syndrome

Trainer, Peter; Grossman, Ashley

doi:10.1111/j.1365-2265.1991.tb03773.x

Cited by 141 publications

(94 citation statements)

References 74 publications

(13 reference statements)

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“…However, the results of the published studies are not readily comparable since different protocols and cut-off values to define cortisol suppression have been used (8). The classical 2-day-dexamethasone test is considered more accurate than the overnight 1-mg dexamethasone suppression test (23), but it is more difficult to perform in the clinical practice. The recent NIH state-of-the-science conference panel on adrenal incidentaloma has recommended the overnight 1-mg DST to screen for autonomous cortisol secretion adopting the traditional cortisol threshold of 5 µg/dL (138 nmol/L) to define adequate suppression (2).…”

Section: Diagnosismentioning

confidence: 99%

Subclinical Cushing's Syndrome

et al. 2004

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Subclinical Cushing's syndrome (CS) is attracting increasing interest since the serendipitous discovery of an adrenal mass has become a rather frequent event owing to the routine use of sophisticated radiologic techniques. Cortical adenoma is the most frequent type of adrenal incidentaloma accounting for approximately 50% of cases in surgical series and even greater shares in medical series. Incidentally discovered adrenal adenomas may secrete cortisol in an autonomous manner that is not fully restrained by pituitary feedback, in 5 to 20% of cases depending on study protocols and diagnostic criteria. The criteria for qualifying subclinical cortisol excess are controversial and presently there is no consensus on a gold standard for the diagnosis of this condition. An increased frequency of hypertension, central obesity, impaired glucose tolerance, diabetes and hyperlipemia has been described in patients with subclinical CS; however, there is still no clear demonstration of the long-term complications of this condition whose management remains largely empirical. Either adrenalectomy or careful observation associated with treatment of the metabolic syndrome have been suggested as treatment options. RESUMO Síndrome de Cushing Subclínica.A síndrome de Cushing subclínica (SCS) tem atraído interesse cada vez maior desde que a descoberta casual de uma massa adrenal se tornou um evento freqüente devido ao emprego rotineiro de técnicas sofisticadas de imagem. O adenoma cortical é o tipo mais freqüente de incidentaloma adrenal, correspondendo a cerca de 50% dos casos em séries cirúrgicas e até mais do que isso em séries médicas. Adenomas adrenais descobertos incidentalmente podem secretar cortisol de maneira autônoma ou não controlada totalmente pelo feedback hipofisário, em 5 a 20% dos casos, dependendo do protocolo de estudo e dos critérios diagnósticos. Os critérios para qualificar um excesso subclínico de cortisol são controversos e atualmente não existe consenso a respeito de "padrão ouro" para o diagnóstico dessa condição. Em pacientes com SCS, tem sido descrita uma freqüência elevada de hipertensão, obesidade central, intolerância à glicose, diabetes e hiperlipemia; entretanto, ainda não existe uma evidente demonstração de complicações a longo prazo dessa condição, cujo manejo permanece amplamente empírico. Tanto a adrenalectomia como a observação cuidadosa, associada com o tratamento da síndrome metabólica, têm sido sugeridos como opções terapêuticas.

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Section: Diagnosismentioning

confidence: 99%

Subclinical Cushing's Syndrome

et al. 2004

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“…Diagnostic difficulties can arise in distinguishing between CS from situations often referred to as pseudo-Cushings states, including severe obesity, high blood pressure and depression among others (10)(11)(12), in which the clinical and biochemical evidence may be confusing. The difficulties in diagnosing CS are also present in childhood and adolescence.…”

Section: Introductionmentioning

confidence: 99%

Salivary cortisol as a tool for physiological studies and diagnostic strategies

Castro

Elias

Martinelli

et al. 2000

Braz J Med Biol Res

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Salivary cortisol is an index of plasma free cortisol and is obtained by a noninvasive procedure. We have been using salivary cortisol as a tool for physiological and diagnostic studies, among them the emergence of circadian rhythm in preterm and term infants. The salivary cortisol circadian rhythm in term and premature infants was established between 8 and 12 postnatal weeks. In the preterm infants the emergence of circadian rhythm was parallel to the onset of sleep rhythm. We also studied the use of salivary cortisol for screening for Cushings syndrome (CS) in control and obese outpatients based on circadian rhythm and the overnight 1 mg dexamethasone (DEX) suppression test. Salivary cortisol was suppressed to less than 100 ng/ dl after 1 mg DEX in control and obese patients. A single salivary cortisol measurement at 23:00 h and again after 1 mg DEX above the 90th percentile of the obese group values had sensitivity and specificity of 93 and 93% (23:00 h), and 91 and 94% (after DEX), respectively. The sensitivity improved to 100% when we combined both parameters. We also studied 11 CS children and 21 age-matched primary obese children for whom salivary cortisol sensitivity and specificity were 100/95% (23:00 h), and 100/95% (1 mg DEX), respectively. Similar to adults, sensitivity and specificity of 100% were obtained by combining 23:00 h and 1 mg DEX. The measurement of salivary cortisol is a useful tool for physiological studies and for the diagnosis of CS in children and adults on an outpatient basis. Correspondence

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“…Catheters are placed bilaterally within the inferior petrosal sinuses and gradients between the central and peripheral plasma ACTH levels are determined with and without CRH administration (18)(19)(20)(21)(22) . Central to peripheral ratios greater than 2.0 are considered indicative of Cushing's disease.…”

Section: Cushing's Diseasementioning

confidence: 99%