medigraphic.com
ISSN 2500-7106 (Electronic)
ISSN 0123-2576 (Print)
Medicina & Laboratorio

2009, Number 09-10

<< Back Next >>

Medicina & Laboratorio 2009; 15 (09-10)

Cushing’s syndrome

Gutiérrez RJ, Latorre SG, Campuzano MG

Language: Spanish
References: 56
Page: 411-430
PDF size: 816.28 Kb.


ABSTRACT

Cushing’s syndrome is the results of chronic exposure to high concentrations of cortisol. Even though it is considered a rare disease, it is characterized by high morbidity and mortality, if untreated; therefore, early diagnosis and identification of its cause is mandatory to initiate the proper management of the patient. The diagnosis of Cushing’s syndrome is a challenge for the endocrinologist and the correct implementation and interpretation of the diagnostic tests require a high degree of clinical knowledge. The diagnosis includes two steps: first, to confirm the hypercortisolemia state with the aid of several screening tests; and second, to identify the cause of the hypercortisolemia. Laboratory results should be interpreted jointly with the clinical aspects and the radiology findings.


REFERENCES

  1. Cushing H. The basophil adenomas of the pituitary body and their clinical manifestations (pituitary basophilism). Bull Johns Hopkins Hosp 1932; 50.

  2. Pivonello R, De Martino MC, De Leo M, Lombardi G, Colao A. Cushing’s syndrome. Endocrinol Metab Clin North Am 2008; 37: 135-149, ix.

  3. Orth DN. Cushing’s syndrome. N Engl J Med 1995; 332: 791-803.

  4. Newell-Price J, Bertagna X, Grossman AB, Nieman LK. Cushing’s syndrome. Lancet 2006; 367: 1605-1617.

  5. Lahera Vargas M, da Costa CV. Prevalence, etiology and clinical findings of Cushing’s syndrome. Endocrinol Nutr 2009; 56: 32-39.

  6. Lindholm J, Juul S, Jorgensen JO, Astrup J, Bjerre P, Feldt-Rasmussen U, et al. Incidence and late prognosis of Cushing’s syndrome: a population- based study. J Clin Endocrinol Metab 2001; 86: 117-123.

  7. Hutter AM, Jr., Kayhoe DE. Adrenal cortical carcinoma. Clinical features of 138 patients. Am J Med 1966; 41: 572-580.

  8. Boscaro M, Arnaldi G. Approach to the patient with possible Cushing’s syndrome. J Clin Endocrinol Metab 2009; 94: 3121-3131.

  9. Wajchenberg BL, Bosco A, Marone MM, Levin S, Rocha M, Lerario AC, et al. Estimation of body fat and lean tissue distribution by dual energy X-ray absorptiometry and abdominal body fat evaluation by computed tomography in Cushing’s disease. J Clin Endocrinol Metab 1995; 80: 2791-2794.

  10. Koch CA, Doppman JL, Watson JC, Patronas NJ, Nieman LK. Spinal epidural lipomatosis in a patient with the ectopic corticotropin syndrome. N Engl J Med 1999; 341: 1399-1400.

  11. Mountjoy KG. The human melanocyte stimulating hormone receptor has evolved to become “supersensitive” to melanocortin peptides. Mol Cell Endocrinol 1994; 102: R7-11.

  12. Adler RA, Rosen CJ. Glucocorticoids and osteoporosis. Endocrinol Metab Clin North Am 1994; 23: 641-654.

  13. Lukert BP, Raisz LG. Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med 1990; 112: 352-364.

  14. Tauchmanova L, Pivonello R, Di Somma C, Rossi R, De Martino MC, Camera L, et al. Bone demineralization and vertebral fractures in endogenous cortisol excess: role of disease etiology and gonadal status. J Clin Endocrinol Metab 2006; 91: 1779-1784.

  15. Teves DA. Clinical approach of cushing syndrome resulting from ACTH-producing metastatic neuroendocrine tumor. The Endocrinologist 2005; 15: 401- 404.

  16. Terzolo M, Allasino B, Bosio S, Brusa E, Daffara F, Ventura M, et al. Hyperhomocysteinemia in patients with Cushing’s syndrome. J Clin Endocrinol Metab 2004; 89: 3745-3751.

  17. Newell-Price J, Grossman A. Diagnosis and management of Cushing’s syndrome. Lancet 1999; 353: 2087-2088.

  18. Nieman LK, Biller BM, Findling JW, Newell-Price J, Savage MO, Stewart PM, et al. The diagnosis of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2008; 93: 1526-1540.

  19. Kola B, Grossman AB. Dynamic testing in Cushing’s syndrome. Pituitary 2008; 11: 155- 162.

  20. Santos S, Santos E, Gaztambide S, Salvador J. [Diagnosis and differential diagnosis of Cushing’s syndrome]. Endocrinol Nutr 2009; 56: 71-84.

  21. Elamin MB, Murad MH, Mullan R, Erickson D, Harris K, Nadeem S, et al. Accuracy of diagnostic tests for Cushing’s syndrome: a systematic review and metaanalyses. J Clin Endocrinol Metab 2008; 93: 1553-1562.

  22. Stewart PM. Classification and pathophysiology of Cushing’s syndrome. In: Larsen PR, Kronenberg HM, Melmed S, Polonsky KS, eds. Kronenberg: Williams Textbook of Endocrinology, 11th ed. Philadelphia; WB Saunders. 2008.

  23. Arnaldi G, Angeli A, Atkinson AB, Bertagna X, Cavagnini F, Chrousos GP, et al. Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab 2003; 88: 5593-5602.

  24. Nieman LK, Ilias I. Evaluation and treatment of Cushing’s syndrome. Am J Med 2005; 118: 1340- 1346.

  25. Castro M, Moreira AC. Screening and diagnosis of Cushing’s syndrome. Arq Bras Endocrinol Metabol 2007; 51: 1191-1198.

  26. Makras P, Toloumis G, Papadogias D, Kaltsas GA, Besser M. The diagnosis and differential diagnosis of endogenous Cushing’s syndrome. Hormones (Athens) 2006; 5: 231-250.

  27. Cizza G, Nieman LK, Doppman JL, Passaro MD, Czerwiec FS, Chrousos GP, et al. Factitious Cushing syndrome. J Clin Endocrinol Metab 1996; 81: 3573-3577.

  28. Wood PJ, Barth JH, Freedman DB, Perry L, Sheridan B. Evidence for the low dose dexamethasone suppression test to screen for Cushing’s syndrome- -recommendations for a protocol for biochemistry laboratories. Ann Clin Biochem 1997; 34 ( Pt 3): 222-229.

  29. Newell-Price J, Trainer P, Perry L, Wass J, Grossman A, Besser M. A single sleeping midnight cortisol has 100% sensitivity for the diagnosis of Cushing’s syndrome. Clin Endocrinol (Oxf); 43: 545-550.

  30. Findling JW, Raff H. Screening and diagnosis of Cushing’s syndrome. Endocrinol Metab Clin North Am 2005; 34: 385-402, ix-x.

  31. Reimondo G, Allasino B, Bovio S, Paccotti P, Angeli A, Terzolo M. Evaluation of the effectiveness of midnight serum cortisol in the diagnostic procedures for Cushing’s syndrome. Eur J Endocrinol 2005; 153: 803-809.

  32. Raff H, Raff JL, Findling JW. Late-night salivary cortisol as a screening test for Cushing’s syndrome. J Clin Endocrinol Metab 1998; 83: 2681-2686.

  33. Erickson D, Natt N, Nippoldt T, Young WF, Jr., Carpenter PC, Petterson T, et al. Dexamethasonesuppressed corticotropin-releasing hormone stimulation test for diagnosis of mild hypercortisolism. J Clin Endocrinol Metab 2007; 92: 2972-2976.

  34. Morris DG, Grossman AB. Dynamic tests in the diagnosis and differential diagnosis of Cushing’s syndrome. J Endocrinol Invest 2003; 26: 64-73.

  35. Newell-Price J, Trainer P, Besser M, Grossman A. The diagnosis and differential diagnosis of Cushing’s syndrome and pseudo-Cushing’s states. Endocr Rev 1998; 19: 647-672.

  36. Dichek HL, Nieman LK, Oldfield EH, Pass HI, Malley JD, Cutler GB, Jr. A comparison of the standard high dose dexamethasone suppression test and the overnight 8-mg dexamethasone suppression test for the differential diagnosis of adrenocorticotropin- dependent Cushing’s syndrome. J Clin Endocrinol Metab 1994; 78: 418-422.

  37. Yanovski JA, Cutler GB, Jr., Chrousos GP, Nieman LK. Corticotropin-releasing hormone stimulation following low-dose dexamethasone administration. A new test to distinguish Cushing’s syndrome from pseudo-Cushing’s states. JAMA 1993; 269: 2232-2238.

  38. Aron DC, Raff H, Findling JW. Effectiveness versus efficacy: the limited value in clinical practice of high dose dexamethasone suppression testing in the differential diagnosis of adrenocorticotropindependent Cushing’s syndrome. J Clin Endocrinol Metab 1997; 82: 1780-1785.

  39. Isidori AM, Kaltsas GA, Mohammed S, Morris DG, Jenkins P, Chew SL, et al. Discriminatory value of the low-dose dexamethasone suppression test in establishing the diagnosis and differential diagnosis of Cushing’s syndrome. J Clin Endocrinol Metab 2003; 88: 5299-5306.

  40. Newell-Price J, Morris DG, Drake WM, Korbonits M, Monson JP, Besser GM, et al. Optimal response criteria for the human CRH test in the differential diagnosis of ACTH-dependent Cushing’s syndrome. J Clin Endocrinol Metab 2002; 87: 1640-1645.

  41. Invitti C, Pecori Giraldi F, de Martin M, Cavagnini F. Diagnosis and management of Cushing’s syndrome: results of an Italian multicentre study. Study Group of the Italian Society of Endocrinology on the Pathophysiology of the Hypothalamic- Pituitary-Adrenal Axis. J Clin Endocrinol Metab 1999; 84: 440-448.

  42. Raff H, Findling JW. A physiologic approach to diagnosis of the Cushing syndrome. Ann Intern Med 2003; 138: 980-991.

  43. Korbonits M, Kaltsas G, Perry LA, Putignano P, Grossman AB, Besser GM, et al. The growth hormone secretagogue hexarelin stimulates the hypothalamo-pituitary-adrenal axis via arginine vasopressin. J Clin Endocrinol Metab 1999; 84: 2489-2495.

  44. Lindsay JR, Nieman LK. Differential diagnosis and imaging in Cushing’s syndrome. Endocrinol Metab Clin North Am 2005; 34: 403-421, x.

  45. Hall WA, Luciano MG, Doppman JL, Patronas NJ, Oldfield EH. Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population. Ann Intern Med 1994; 120: 817-820.

  46. Choyke PL. Commentary on “computed tomography in the diagnosis of adrenal disease” and “nonfunctioning adrenal masses: incidental discovery on computed tomography”. AJR Am J Roentgenol 2009; 192: 568-570.

  47. Honigschnabl S, Gallo S, Niederle B, Prager G, Kaserer K, Lechner G, et al. How accurate is MR imaging in characterisation of adrenal masses: update of a long-term study. Eur J Radiol 2002; 41: 113-122.

  48. Mansmann G, Lau J, Balk E, Rothberg M, Miyachi Y, Bornstein SR. The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev 2004; 25: 309-340.

  49. Sohaib SA, Rockall AG, Reznek RH. Imaging functional adrenal disorders. Best Pract Res Clin Endocrinol Metab 2005; 19: 293-310.

  50. Kurtaran A, Traub T, Shapiro B. Scintigraphic imaging of the adrenal glands. Eur J Radiol 2002; 41: 123-130.

  51. Avram AM, Fig LM, Gross MD. Adrenal gland scintigraphy. Semin Nucl Med 2006; 36: 212- 227.

  52. Gross MD, Avram A, Fig LM, Rubello D. Contemporary adrenal scintigraphy. Eur J Nucl Med Mol Imaging 2007; 34: 547-557.

  53. Kaltsas GA, Giannulis MG, Newell-Price JD, Dacie JE, Thakkar C, Afshar F, et al. A critical analysis of the value of simultaneous inferior petrosal sinus sampling in Cushing’s disease and the occult ectopic adrenocorticotropin syndrome. J Clin Endocrinol Metab 1999; 84: 487-492.

  54. Colao A, Faggiano A, Pivonello R, Pecori Giraldi F, Cavagnini F, Lombardi G. Inferior petrosal sinus sampling in the differential diagnosis of Cushing’s syndrome: results of an Italian multicenter study. Eur J Endocrinol 2001; 144: 499-507.

  55. Utz A, Biller BM. The role of bilateral inferior petrosal sinus sampling in the diagnosis of Cushing’s syndrome. Arq Bras Endocrinol Metabol 2007; 51: 1329-1338.

  56. Ilias I, Chang R, Pacak K, Oldfield EH, Wesley R, Doppman J, et al. Jugular venous sampling: an alternative to petrosal sinus sampling for the diagnostic evaluation of adrenocorticotropic hormonedependent Cushing’s syndrome. J Clin Endocrinol Metab 2004; 89: 3795-3800.




2020     |     www.medigraphic.com