The diagnosis and differential diagnosis of endogenous Cushing?s syndrome

Makras, Polyzois; Toloumis, Georgios; Papadogias, Dimitrios; Kaltsas, Gregory; Besser, Michael

doi:10.14310/horm.2002.11189

Cited by 30 publications

(25 citation statements)

References 147 publications

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“…On the other hand, in cases with EAS, 44% (4/9) responded to DDAVP. A prior study also shows that 30-60% of cases with EAS responded to DDAVP [8,9]. These results suggest that the DDAVP test is a sensitive screening test for ACTH-dependent Cushing's syndrome, but does not discriminate it effectively from EAS.…”

Section: Bmentioning

confidence: 90%

“…In all cases with EAS, plasma ferential diagnosis of the Cushing's disease from EAS shows (a) normal or exaggerated response of plasma ACTH levels to the human corticotropin-releasing hormone (hCRH) test, (b) suppression of cortisol (less than half, compared with the basal level) by high-dose (8 mg) overnight DST, (c) the presence of a pituitary adenoma by magnetic resonance imaging (MRI), and (d) positive results by a selective venous sampling test. DST and CRH tests are well known for the diagnosis of Cushing's disease [3,5]. ACTH release would be caused by an abnormal increase in vasopressin type 1b receptors in response to a vasopressin type 2 receptor agonist, DDAVP, on pituitary corticotroph adenoma cells [6], and has been used for the differential diagnosis of ACTH-dependent Cushing's syndrome [7].…”

Section: Low-dose Dexamethasone Suppression Test (Dst)mentioning

confidence: 99%

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Evaluation of Diagnostic Tests for ACTH-Dependent Cushing’s Syndrome

et al. 2009

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because of the Cushingoid appearance, with the characteristic features of central obesity, moon face, skin atrophy, purple striae and buffalo hump, and the clinical criteria are clear, a debate exists in the literature over the biochemical diagnosis of this disease [3]. Recently, the diagnostic criteria for Cushing's disease have been reported by the Ministry of Health, Labour, and Welfare of Japan [4]. In the guideline, the following endocrinological findings were considered as diagnostic criteria: 1) The presence of a Cushingoid appearance; 2) Evidence of autonomic or abnormal secretion of ACTH, such as (a) normal-high ACTH and cortisol levels, and (b) high levels of urinary excretion of free cortisol; 3) Screening tests show (a) incomplete suppression of cortisol (> 5 µg/dl) by a lowdose (0.5 mg) overnight dexamethasone suppression test (DST), (b) high cortisol levels (> 5 µg/dl) during night time sleeping, and (c) response of plasma ACTH levels to the desmopressin (DDAVP) test; 4) The dif- Abstract. We evaluated the usefulness and accuracy of diagnostic tests for adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome, based on our experience of 88 cases, including 73 cases with Cushing's disease, and 15 cases with ectopic ACTH syndrome (EAS). In our study, 0.5 mg of dexamethasone failed to suppress the morning cortisol secretion in 100% of cases with Cushing's disease and EAS. Plasma ACTH levels were significantly increased by desmopressin (DDAVP) in 86% of cases with Cushing's disease, especially in microadenomas (90%), while these levels were not affected in normal subjects. In EAS, 44% responded to DDAVP. Plasma ACTH levels were increased in response to the human corticotropin-releasing hormone (CRH) test in 100% of microadenomas and 73% of macroadenomas with Cushing's disease, but only in 27% of cases with EAS. A high dose (8 mg) of dexamethasone suppressed the morning cortisol secretion in 89% of microadenomas with Cushing's disease, and in 82% of all cases with Cushing's disease, while it did in only 20% of cases with EAS. Taken together, the 0.5 mg dexamethasone suppression test (DST) and DDAVP test are considerably useful for the screening of ACTH-dependent Cushing's syndrome. The CRH test and 8 mg DST would be effective for the diagnosis of Cushing's diseases, because our study shows a sensitivity of 81% in cases with Cushing's disease when these tests are considered together. These data were submitted to prepare the diagnostic criteria for Cushing's disease, suggested by the working group of the Ministry of Health, Labour, and Welfare of Japan.

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Section: Bmentioning

confidence: 90%

Section: Low-dose Dexamethasone Suppression Test (Dst)mentioning

confidence: 99%

Evaluation of Diagnostic Tests for ACTH-Dependent Cushing’s Syndrome

et al. 2009

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“…[1][2][3][4][5][6][7][8][9][10] The clini-cal features are due to the effect of chronic cortisol excess on various tissues. The most common cause of endogenous CS is pituitary corticotroph adenoma (Cushing's disease -CD).…”

Section: Introductionmentioning

confidence: 99%

Cushing's disease: Results of treatment and factors affecting outcome

Ammini

Bhattacharya

Sahoo

et al. 2011

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ObjectIve: to analyze the therapeutic results of intervention and the factors affecting the outcome of patients with cushing's disease (cD) cared for at the All Indian Institute of Medical science (AIIMs), New Delhi. DesIGN. Patients with cushing's disease treated at a teritiary care centre from january 2000 to December 2009 were prospectively studied. resULts. Ninetyseven patients received treatment for cD during this period. Mean duration of follow-up was 3.4 ± 2.2 (mean±sD) years. eighty-one patients (83.5%) underwent transsphenoidal surgery (tss) as the primary treatment modality. Fifty-four patients (66.7%) went into remission after initial tss; ten (18.5%) of them relapsed after a mean follow-up period of 2.9±2.1 (mean±sD) years. Histopathologic examination of resected tissue showed corticotroph adenoma in 48 of the 54 (88.9%) who went into remission and 17 of the 27 (63.0%) who did not go into remission after the initial tss. sixteen patients with severe hypercortisolism underwent bilateral adrenalectomy (bA) as a life-saving measure which was followed by pituitary surgery 6 to 12 months later. Five patients including one with a large macroadenoma required three or more procedures to achieve eucortisolism. cONcLUsION: Fifty-four out of 81 (66.7%) of our patients with cD had remission following initial tss, ten of whom relapsed later on. sixteen patients unerwent bA as a life-saving procedure. Factors affecting outcome were, age, gender, low dose dexamethasone suppression test cortisol value and histologic confirmation of corticotroph adenoma.

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“…corticotropin-releasing hormone (CrH) test are well defined for the diagnosis of Cushing's syndrome [4][5][6], while desmopressin has been used for the differential diagnosis of ACTH-dependent Cushing's syndrome [7,8]. However, it is clear that the diagnosis and differential diagnosis of Cushing's syndrome are still challenging problems in clinical endocrinology [9,10].…”

mentioning

confidence: 99%

“…However, it is clear that the diagnosis and differential diagnosis of Cushing's syndrome are still challenging problems in clinical endocrinology [9,10].…”

mentioning

confidence: 99%