A Clinical Index for Rating Severity in Cushing’s Syndrome

Sonino, Nicoletta; Boscaro, Marco; Fallo, Francesco; Fava, G. A.

doi:10.1159/000012396

Cited by 53 publications

(33 citation statements)

References 19 publications

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“…The results of the current study confirm and expand those of a previous series, showing that UFC levels alone [12,33]. However, in the study of Petersenn et al patients had a pituitary disease, while in our study also patients with adrenal disease were evaluated.…”

Section: Discussionsupporting

confidence: 90%

The degree of urinary hypercortisolism is not correlated with the severity of cushing’s syndrome

et al. 2016

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Cushing syndrome (CS) is characterized by increased morbidity and mortality compared to the general population. However, there are patients who have more clinical aggressive forms than others. Aim of the study is to evaluate whether the degree of hypercortisolism, defined by the number of times urinary free cortisol (UFC) levels exceed the upper limit of the normal range (ULN), is related to the worsening of phenotypic features, as well as metabolic and cardiovascular parameters, in a cohort of CS patients. A cross-sectional study was conducted on 192 patients with active CS, consecutively presenting at the outpatients' clinic of the University Hospitals of Ancona, Naples, and Palermo. Patients were grouped into mild (UFC not exceeding twice the ULN), moderate (2-5 times the ULN), and severe (more than 5 times the ULN) hypercortisolism. Thirty-seven patients (19.3 %) had mild, 115 (59.8 %) moderate, and 40 (20.9 %) severe hypercortisolism. A significant trend of increase among the three groups was demonstrated for 8-, 16-, and 24-h serum cortisol levels (p \ 0.001) and serum cortisol after low dose of dexamethasone suppression test (p = 0.001). No significant trend of increase was found regarding phenotype and comorbidities. The degree of hypercortisolism by itself does not appear to be a sufficient parameter to express the severity of CS. Therefore, estimating the severity of CS according to biochemical parameters remains a challenge, while the clinical phenotype and the associated comorbidities might be more useful to assessing the severity of the CS.

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Section: Discussionsupporting

confidence: 90%

The degree of urinary hypercortisolism is not correlated with the severity of cushing’s syndrome

et al. 2016

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“…Many methodological pitfalls are involved in the literature on the exploration of subclinical symptomatology in affective disorders. It would be useful to find an assessment tool able to capture small changes in symptomatology [47], such as the life chart method [48]. This and other mood charts may be useful to identify the clinical course of the illness, treatments and triggering factors, and especially to look for suitable prophylactic psychopharmacological and psychological tools, such as the well-being therapy which has been found to be associated with a significant reduction in residual symptoms in patients with affective disorders [49].…”

Section: Discussionmentioning

confidence: 99%

Executive Function in Patients with Remitted Bipolar Disorder and Schizophrenia and Its Relationship with Functional Outcome

Martínez‐Arán

Penadés

Vieta

et al. 2001

Psychother Psychosom

167

121

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Background: Recent studies have reported that differences in cognitive performance between schizophrenic and bipolar patients seem to be smaller than expected. Patients with schizophrenia have consistently shown frontal executive dysfunctions, but studies regarding executive abilities in bipolar patients are scarce and discrepant. As executive function has been associated with psychosocial functioning in schizophrenia, we wanted to investigate if such a relationship is also present in bipolar disorder and the differences between the two groups. Methods: Executive function was assessed in 49 euthymic (at least 6 months in remission, Hamilton Depression Rating Scale ≤8 and Young Mania Rating Scale ≤6) bipolar and in 49 schizophrenic, residual-type (with at least 1 year without acute exacerbation and predominant negative symptomatology) patients, by the Wisconsin Card Sorting Test (WCST), FAS Test (COWAT) and Trail Making Test. Baseline clinical and psychosocial variables were controlled and psychopathology evaluated by means of the Positive and Negative Syndrome Scale (PANSS). Results: The two groups showed a similar pattern of cognitive deficits in tests of executive function, except for the number of categories achieved in the WCST, which was significantly lower in the schizophrenic group (F = 7.26; p = 0.009). Functional outcome was predicted by the negative syndrome (PANSSN) and perseverative errors (WCST) in schizophrenic patients, and general psychopathology (PANSSG) was the best predictor of functional outcome in the bipolar group. Conclusion: Executive function was a good predictor of functional outcome in the schizophrenic group, whereas clinical variables were more predictive of the bipolar one. Patterns of cognitive disturbances in tasks of executive function are similar in both groups but quantitatively more marked in schizophrenia.

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“…In all cases of ACS and EAS, the diagnosis was histologically confirmed. Thirty-four patients were diagnosed as having mild CS by two clinicians (G R and M T), who derived the diagnosis from clinical history, physical examination and routine laboratory data, without relying on endocrine data, according to the recently validated CS severity index (CSI) (21). The patients were 8 men and 26 women with a median age of 57 years (range 14 -80); etiology of mild CS was 23 CD, 8 ACS and 3 EAS ( Table 2).…”

Section: Methodsmentioning

confidence: 99%

Evaluation of the effectiveness of midnight serum cortisol in the diagnostic procedures for Cushing’s syndrome

et al. 2005

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Objective: It is presently unclear whether the accuracy of midnight serum cortisol (F24) in the diagnosis of Cushing's syndrome (CS) may be replicated under usual conditions of clinical care. The aim of the present study was to assess retrospectively the effectiveness of F24 for confirming the diagnosis in a consecutive series of 106 patients, in 78 of whom a definitive diagnosis of CS was made. Design and methods: We have compared the results of F24, urinary free cortisol (UFC) and the overnight 1 mg dexamethasone suppression test (DST) with the definitive clinical diagnosis. Receiver operating characteristic (ROC) analysis has been performed to define the best cutoff values, the sensitivity (Se) and the specificity (Sp) of the tests. Results: The best cutoff value for F24 was 8.3 mg/dl (Se 91.8%; Sp 96.4%). The best cutoff value for the DST was 4.0 mg/dl (Se 89.2%; Sp 90.9%). The best cutoff value for UFC was 238 mg/24 h (Se 73.2%; Sp 96.3%). The area under the curve of F24 was significantly greater than that of UFC, both in the overall series (P ¼ 0.004) and in the subgroup of patients with mild CS (P ¼ 0.02). The differences were analyzed by means of the two-tailed students's t-test. With the thresholds generated by the ROC analysis, UFC would have failed to achieve the correct diagnosis in a significantly higher percentage of cases than F24 (20.4% vs 7.9%; P ¼ 0.01). The difference was analyzed by means of the chi-squared test with Yates correction. Conclusions:The present results show that F24 has excellent effectiveness in the diagnostic procedures for CS in stressed conditions (patients studied in a hospital ward in a nonsleeping state). The test appears to be accurate also for patients with mild hypercortisolism.European Journal of Endocrinology 153 803-809

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A Clinical Index for Rating Severity in Cushing’s Syndrome

Cited by 53 publications

References 19 publications

The degree of urinary hypercortisolism is not correlated with the severity of cushing’s syndrome

The degree of urinary hypercortisolism is not correlated with the severity of cushing’s syndrome

Executive Function in Patients with Remitted Bipolar Disorder and Schizophrenia and Its Relationship with Functional Outcome

Evaluation of the effectiveness of midnight serum cortisol in the diagnostic procedures for Cushing’s syndrome

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