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Cushing Response

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1. Cushing's syndrome

, and is responsible for 70% to 80% of cases. Though uncommon, the prevalence of endogenous Cushing syndrome is greater than previously thought. It may be difficult to distinguish patients with mild Cushing syndrome from those with the metabolic syndrome (central obesity with insulin resistance, and hypertension). Features more specific to Cushing syndrome include proximal muscle weakness, supraclavicular fat pads, facial plethora, violaceous striae, easy bruising, and premature osteoporosis. After exclusion (...) Cushing's syndrome Cushing syndrome - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Cushing syndrome Last reviewed: February 2019 Last updated: October 2018 Summary The clinical manifestation of pathological hypercortisolism from any cause. Cushing's disease, which is hypercortisolism caused by an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma, is the most common cause of Cushing's syndrome

2018 BMJ Best Practice

2. Cushing syndrome

, and is responsible for 70% to 80% of cases. Though uncommon, the prevalence of endogenous Cushing syndrome is greater than previously thought. It may be difficult to distinguish patients with mild Cushing syndrome from those with the metabolic syndrome (central obesity with insulin resistance, and hypertension). Features more specific to Cushing syndrome include proximal muscle weakness, supraclavicular fat pads, facial plethora, violaceous striae, easy bruising, and premature osteoporosis. After exclusion (...) Cushing syndrome Cushing syndrome - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Cushing syndrome Last reviewed: February 2019 Last updated: October 2018 Summary The clinical manifestation of pathological hypercortisolism from any cause. Cushing's disease, which is hypercortisolism caused by an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma, is the most common cause of Cushing's syndrome

2018 BMJ Best Practice

3. A case of autonomous cortisol secretion in a patient with subclinical Cushing's syndrome, GNAS mutation, and paradoxical cortisol response to dexamethasone. (PubMed)

A case of autonomous cortisol secretion in a patient with subclinical Cushing's syndrome, GNAS mutation, and paradoxical cortisol response to dexamethasone. Increased urinary free cortisol in response to the oral administration of dexamethasone is a paradoxical reaction mainly reported in patients with primary pigmented nodular adrenocortical disease. Here, we describe the first case of subclinical Cushing's syndrome represented by autonomous cortisol secretion and paradoxical response to oral (...) dexamethasone administration, harboring an activating mutation in the α subunit of the stimulatory G protein (GNAS).A 65-year-old woman was diagnosed with subclinical Cushing's syndrome during an evaluation for bilateral adrenal masses. Tumors of unknown origin were found in the heart, brain, thyroid gland, colon, pancreas, and both adrenal glands. Adenocarcinoma of the sigmoid colon and systemic brown-patchy skin pigmentation were also present. Her urinary cortisol levels increased in response to oral

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2019 BMC Endocrine Disorders

4. Endocrine Remission After Pituitary Stereotactic Radiosurgery: Differences in Rates of Response for Matched Cohorts of Cushing Disease and Acromegaly Patients. (PubMed)

Endocrine Remission After Pituitary Stereotactic Radiosurgery: Differences in Rates of Response for Matched Cohorts of Cushing Disease and Acromegaly Patients. To compare and describe the time to endocrine remission and new hypopituitarism among patients with growth hormone (GH) and adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas after radiosurgery, controlling for several known prognostic factors.An institutional review board-approved, institutional retrospective analysis

2018 Biology and Physics

5. The Investigation of suspected Paediatric Cushing?s Syndrome

ages is iatrogenic, secondary to exogenous glucocorticoid administration e.g. inhaled, oral, parenteral or topical corticosteroids. Therefore, if CS is suspected, it is fundamental to take a thorough medication history to exclude exogenous CS (2). Cushing’s disease (CD), caused by an ACTH-secreting pituitary adenoma, is responsible for 75-85% cases of endogenous paediatric CS (1, 6, 7). Table 1. Simple classification of paediatric Cushing’s syndrome (CS) ACTH-independent 1. Exogenous glucocorticoid (...) The Investigation of suspected Paediatric Cushing?s Syndrome 1 The Investigation of suspected paediatric Cushing’s Syndrome (hypercortisolaemia) Formulated by Ingrid. C.E. Wilkinson, Martin O. Savage, William M. Drake and Helen L. Storr in February 2018. Centre for Endocrinology, William Harvey Research Institute (WHRI), Charterhouse Square, Barts and the London School of Medicine, London EC1M 6BQ. Revision due: February 2021 Scope To guide UK paediatric endocrinologists in the investigation

2018 British Society for Paediatric Endocrinology and Diabetes

6. Late-night salivary cortisol may be valuable for assessing treatment response in patients with Cushing's disease: 12-month, Phase III pasireotide study. (PubMed)

Late-night salivary cortisol may be valuable for assessing treatment response in patients with Cushing's disease: 12-month, Phase III pasireotide study. Measuring salivary cortisol is a simple, convenient and accurate technique with potential value in monitoring patients with hypercortisolism. This analysis reports changes in late-night salivary cortisol (LNSC) during a 12-month, multicentre, Phase III study of patients with Cushing's disease who were randomized to pasireotide 600 or 900 μg sc (...) LNSC and UFC values when all time points were pooled. Pasireotide decreased LNSC levels during 12 months of treatment. Salivary cortisol may be a simple, convenient biomarker for assessing treatment response in patients with Cushing's disease.

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2016 Endocrine

7. Cushing Response

Cushing Response Cushing Response Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Cushing Response Cushing Response Aka: Cushing (...) Response , Cushing's Response , Cushing Reflex , Cushing's Reflex , Cushing Effect , Cushing Reaction , Cushing Phenomenon , Cushing's Law II. Pathophysiology Hypertensive response in face of increased ICP Helps maintain cerebral perfusion III. Signs: Triad Systolic increase Irregular respiration IV. Causes Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Cushing Response." Click on the image (or right click) to open the source

2018 FP Notebook

8. Cushing Response

Cushing Response Cushing Response Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Cushing Response Cushing Response Aka: Cushing (...) Response , Cushing's Response , Cushing Reflex , Cushing's Reflex , Cushing Effect , Cushing Reaction , Cushing Phenomenon , Cushing's Law II. Pathophysiology Hypertensive response in face of increased ICP Helps maintain cerebral perfusion III. Signs: Triad Systolic increase Irregular respiration IV. Causes Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Cushing Response." Click on the image (or right click) to open the source

2018 FP Notebook

9. Predictors of outcome after pituitary surgery for cushing's disease: a systematic review and meta-analysis

Predictors of outcome after pituitary surgery for cushing's disease: a systematic review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any associated files

2019 PROSPERO

10. Adipocyte GR inhibits healthy adipose expansion through multiple mechanisms in Cushing's syndrome. (PubMed)

syndrome and adipocyte-specific GR knockout (AGRKO) mice, we investigated the roles of adipocyte GR and its clinical relevance in Cushing syndrome. Under chronic treatment with corticosterone, AGRKO mice underwent healthy adipose expansion with diminished ectopic lipid deposition and improved insulin sensitivity. These changes were associated with Atgl-mediated lipolysis through a novel intronic glucocorticoid-responsive element. Additionally, integrated analysis with RNA sequencing of AGRKO mice (...) Adipocyte GR inhibits healthy adipose expansion through multiple mechanisms in Cushing's syndrome. In Cushing syndrome, excessive glucocorticoids lead to metabolic disturbances, such as insulin resistance, adipocyte hypertrophy, and liver steatosis. In vitro experiments have highlighted the importance of adipocyte glucocorticoid receptor (GR), but its metabolic roles in vivo have not been fully elucidated in Cushing syndrome. In this study, using clinical samples from patients with Cushing

2019 Endocrinology

11. Alterations in Protein Kinase A Substrate Specificity as a Potential Cause of Cushing's Syndrome. (PubMed)

Alterations in Protein Kinase A Substrate Specificity as a Potential Cause of Cushing's Syndrome. Cushing syndrome is a severe endocrine disorder of cortisol excess associated with major metabolic and cardiovascular sequelae. We recently identified somatic mutations in PRKACA, the gene encoding the catalytic (C) α subunit of protein kinase A (PKA), as being responsible for cortisol-producing adrenocortical adenomas (CPAs), which are a major cause of Cushing syndrome. In spite of previous (...) studies on the two initially identified mutations (L206R, 199_200insW), the mechanisms of action of the clinically highly relevant PRKACA mutations remain poorly understood. Here, by investigating a large panel of PRKACA mutations, including all those identified so far in Cushing syndrome, we unexpectedly found that not all mutations interfere with the binding of regulatory (R) subunits as previously hypothesized. Because several mutations lie in a region of PKA Cα involved in substrate recognition

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2019 Endocrinology

12. Improvement in cognitive impairment following the successful treatment of endogenous Cushing's syndrome-a case report and literature review. (PubMed)

Improvement in cognitive impairment following the successful treatment of endogenous Cushing's syndrome-a case report and literature review. Endogenous Cushing's syndrome, a rare endocrine disorder, characterised by chronic cortisol hypersecretion, results in neuropsychiatric disturbances and in cognitive deficits, which are only partially reversible after the biochemical remission of the disease.We report a case of a woman with a profound cognitive deficit and a gradual functional decline (...) caused by Cushing's disease of at least 10 years duration. The neurosurgical resection of her 2 mm adrenocorticotropic hormone (ACTH) secreting pituitary microadenoma resulted in a successful resolution of the patient's hypercortisolism and a significant recovery of her neurocognitive function. The patient's progress was evaluated using serial clinical observations, functional assessments, Mini-Mental Status exams and through the formal neuropsychological report. Furthermore, the patient's recovery

2019 BMC Endocrine Disorders

13. Cushing's syndrome due to interaction between ritonavir or cobicistat and corticosteroids: a case-control study in the French Pharmacovigilance Database. (PubMed)

Cushing's syndrome due to interaction between ritonavir or cobicistat and corticosteroids: a case-control study in the French Pharmacovigilance Database. To explore the frequent interaction between antiretroviral-boosting agents and corticosteroids causing Cushing's syndrome (CS) in the French Pharmacovigilance Database (FPVD).We conducted a retrospective case-control study describing CS recorded in the FPVD between 1996 and 2018. Case was defined as CS occurring in people living with HIV (PLWH (...) fluticasone (28/35, 80%) among the cases and oral prednisone (38/104, 37%) among the controls. More CS cases (30/35, 86%) than CS controls (62/104, 60%) were serious (OR = 4.0, 95% CI = 1.4-14.4; P = 0.007).Antiretroviral-boosting agents were responsible for one out of four iatrogenic CS cases in a French national database. Prescribers should be aware of the risk of potentially serious DDIs between antiretroviral-boosting agents and corticosteroids, including single-tablet regimens containing cobicistat.©

2019 Journal of Antimicrobial Chemotherapy

14. Treatment of Cushing's Syndrome

or unlikely to address the excess cortisol. Surgical removal of the tumor is optimal because it leaves intact the hypothalamic-pituitary-adrenal axis, which is integral to the body’s central stress response. Summary of Recommendations 1.1 In patients with overt Cushing's syndrome (CS), we recommend normalizing cortisol levels or action at its receptors to eliminate the signs and symptoms of CS and treating comorbidities associated with hypercortisolism. (1|⊕⊕⊕⚪) 1.2 We recommend against treatment (...) Treatment of Cushing's Syndrome '); '); Treatment of Cushing's Syndrome Guideline Resources | Endocrine Society Hormone Science to Health / › › › Guidelines and Clinical Practice Section + Treatment of Cushing's Syndrome Guideline Resources Full Guideline: JCEM | August 2015 Lynnette K. Nieman (chair), Beverly M. K. Biller, James W. Findling, M. Hassan Murad, John Newell-Price, Martin O. Savage, and Antoine Tabarin The 2015 guideline addresses: Picking the optimal treatment to address

2015 The Endocrine Society

15. Efficacy and safety of once-monthly pasireotide in Cushing's disease: a 12 month clinical trial. (PubMed)

Efficacy and safety of once-monthly pasireotide in Cushing's disease: a 12 month clinical trial. Cushing's disease is a rare debilitating endocrine disorder for which few prospective interventional studies have been done. We report results of the first phase 3 trial assessing long-acting intramuscular pasireotide in patients with Cushing's disease.In this phase 3 clinical trial we recruited patients aged 18 years or older with persistent, recurrent, or de-novo (non-surgical candidates (...) ) Cushing's disease who had a mean urinary free cortisol (mUFC) concentration (from three 24 h samples) of 1·5-5·0 times the upper limit of normal (ULN), a normal or greater than normal morning plasma adrenocorticotropic hormone concentration, and a pituitary source of Cushing's syndrome, from 57 sites across 19 countries. Exclusion criteria included previous pasireotide treatment, mitotane therapy within 6 months, and pituitary irradiation within 10 years. We randomly allocated patients 1:1 (block size

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2018 The lancet. Diabetes & endocrinology

16. DIAGNOSIS OF ENDOCRINE DISEASE: The role of the desmopressin test in the diagnosis and follow-up of Cushing's syndrome. (PubMed)

elicits an ACTH and cortisol response, which contrasts with the minimal responses obtained in healthy subjects. The mechanism underlying this paradoxical response involves upregulation of vasopressin type 3 and/or the aberrant expression of type 2 receptors by neoplastic ACTH-producing cells. This makes desmopressin administration a suitable test enabling the distinction between neoplastic from functional (formerly termed 'pseudo-Cushing syndrome') ACTH-dependent cortisol excess. Several studies have (...) now established an adjunctive role of desmopressin in the initial diagnostic workup of CS. Despite some early data indicating that this test may also have a role in distinguishing between Cushing's disease (CD) and ectopic ACTH secretion, subsequent studies failed to confirm this observation. The ability of the paradoxical response to desmopressin to depict the presence of neoplastic ACTH-secreting cells was also exploited in the follow-up of patients with CD undergoing surgery. Loss

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2018 European Journal of Endocrinology

17. MANAGEMENT OF ENDOCRINE DISEASE: Management of Cushing's syndrome during Pregnancy: solved and unsolved questions. (PubMed)

cortisol appear valid. Apart from gestational hypertension, differential diagnosis includes pheochromocytoma and primary aldosteronism. The predominant cause is adrenal adenoma (sometimes without decreased ACTH), rather than Cushing's disease. There are considerable imaging pitfalls in Cushing's disease. Aberrant receptors may, in rare cases, lead to increased cortisol production during pregnancy in response to HCG, LHRH, glucagon, vasopressin or after a meal. Adrenocortical carcinoma (ACC) is rare (...) MANAGEMENT OF ENDOCRINE DISEASE: Management of Cushing's syndrome during Pregnancy: solved and unsolved questions. With fewer than 200 reported cases, Cushing's syndrome (CS) in pregnancy remains a diagnostic and therapeutic challenge. In normal pregnancies, misleading signs may be observed such as striae or hypokalemia, while plasma cortisol and urinary free cortisol may rise up to 2- to 3-fold. While the dexamethasone suppression test is difficult to use, reference values for salivary

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2018 European Journal of Endocrinology

18. Pharmacokinetic (PK), Pharmacodynamic (PD) and Tolerability of Osilodrostat in Pediatric Patients With Cushing's Disease

number of saved studies (100). Please remove one or more studies before adding more. Pharmacokinetic (PK), Pharmacodynamic (PD) and Tolerability of Osilodrostat in Pediatric Patients With Cushing's Disease The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details (...) . ClinicalTrials.gov Identifier: NCT03708900 Recruitment Status : Not yet recruiting First Posted : October 17, 2018 Last Update Posted : December 14, 2018 See Sponsor: Novartis Pharmaceuticals Information provided by (Responsible Party): Novartis ( Novartis Pharmaceuticals ) Study Details Study Description Go to Brief Summary: Multicenter, open-label, non-comparative study to evaluate the pharmacokinetics, pharmacodynamics, and tolerability of osilodrostat in children and adolescent patients with Cushing's

2018 Clinical Trials

19. Rebound thymic hyperplasia after adrenalectomy in a patient with Cushing syndrome caused by adrenocortical adenoma: A case report. (PubMed)

Rebound thymic hyperplasia after adrenalectomy in a patient with Cushing syndrome caused by adrenocortical adenoma: A case report. The development of rebound thymic hyperplasia (RTH) has been reported in patients who have recovered from stressful conditions such as surgery and steroid therapy. We report a case of RTH following the resolution of hypercortisolism after adrenalectomy for the treatment of adrenocortical adenoma in a patient with Cushing syndrome.A 5-month-old female infant (...) with a history of overeating, hirsutism, and excessive weight gain for the previous 2 months was referred to the hospital. The laboratory results revealed elevated 24-hour urinary free cortisol levels. An overnight dexamethasone suppression test showed no response. Abdominal imaging revealed a right-sided suprarenal mass measuring 4_3cm. Histology showed an adrenocortical adenoma. Thus, she underwent a right adrenalectomy.The patient showed clinical improvement with weight loss and normal cortisol levels

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2018 Medicine

20. Clinical Investigation of Adrenal Incidentalomas in Japanese Patients of the Fukuoka Region with Updated Diagnostic Criteria for Sub-clinical Cushing's Syndrome (PubMed)

the functional tumors, but for sub-clinical Cushing's syndrome, we used an updated set of diagnosis criteria: serum cortisol ≥1.8 μg/dL after a positive response to a 1-mg dexamethasone suppression test if the patient has a low morning adrenocorticotropic hormone (ACTH) level (<10 pg/mL) and a loss of the diurnal serum cortisol rhythm. Results Of the 61 patients, none (0%) had malignant tumors, 8 (13.1%) had pheochromocytoma, and 15 (24.6%) had primary aldosteronism; when diagnosed by our revised criteria (...) Clinical Investigation of Adrenal Incidentalomas in Japanese Patients of the Fukuoka Region with Updated Diagnostic Criteria for Sub-clinical Cushing's Syndrome Objectives We retrospectively investigated the clinical and endocrinological characteristics of adrenal incidentalomas. Methods We studied 61 patients who had been diagnosed with adrenal incidentalomas and had undergone detailed clinical and endocrinological evaluations while hospitalized. We used common criteria to diagnose

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2018 Internal Medicine

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