Cushing's syndrome

Newell‐Price, John; Bertagna, Xavier; Grossman, Ashley; Nieman, Lynnette K.

doi:10.1016/s0140-6736(06)68699-6

Cited by 1,153 publications

(841 citation statements)

References 147 publications

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“…For instance, increased total plasma cortisol is a typical finding in people with Cushing's Disease68, 69 but is not commonly observed in horses and ponies with PPID 2. Further, atherosclerosis and related cardiovascular disease (ie, stroke, myocardial infarction) are a key aspect of Metabolic Syndrome in people and are associated with increases in total and free cortisol,34, 70 but these clinical abnormalities are not appreciated in EMS 1, 31.…”

Section: Discussionmentioning

confidence: 99%

Effect of Age, Season, Body Condition, and Endocrine Status on Serum Free Cortisol Fraction and Insulin Concentration in Horses

Hart

Wochele

Norton

et al. 2016

Veterinary Internal Medicne

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BackgroundIncreased free cortisol fraction is associated with insulin dysregulation (ID) in people with Metabolic Syndrome and Cushing's Disease. Free cortisol has not been investigated in equine endocrine disorders.Hypotheses(1) In healthy horses, sex, age, body condition score (BCS), and season impact free cortisol; (2) free cortisol is increased in horses with Pituitary Pars Intermedia Dysfunction (PPID) or Equine Metabolic Syndrome (EMS).AnimalsFifty‐seven healthy horses; 40 horses and ponies with PPID (n = 20) or EMS (n = 20).MethodsProspective study. Serum collected seasonally from healthy animals and archived serum from PPID and EMS animals was analyzed for insulin, total and free cortisol concentrations, and free cortisol fraction (FCF). Linear mixed models were used to determine effects of age, sex, season, and BCS on hormones in controls. Hormone measurements were compared between disease groups and age‐ and season‐matched controls with t‐tests. EMS and hyperinsulinemic PPID animals were combined in an ID (hyperinsulinemia) group.ResultsFree cortisol concentrations were increased in overweight/obese controls (0.3 ± 0.1 μg/dL) compared to lean controls (0.2 ± 0.1 μg/dL; P = .017). Mean FCF was significantly higher in animals with PPID (8.8 ± 5.8 μg/dL, P = .005) or ID (8.8 ± 10.2 μg/dL, P = .039) than controls (5.0 ± 0.9 μg/dL), but total cortisol concentrations were similar (P ≥ .350) (PPID: 4.2 ± 4.3 μg/dL; ID: 5.0 ± 4.5 μg/dL; controls: 4.6 ± 1.7 and 5.1 ± 2.1 μg/dL).Conclusions and Clinical ImportanceIncreased FCF is associated with obesity in healthy horses and with ID (hyperinsulinemia) in horses and ponies with endocrine disease. Decreased plasma cortisol‐binding capacity could be a component of these endocrine disorders in horses.

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Section: Discussionmentioning

confidence: 99%

Effect of Age, Season, Body Condition, and Endocrine Status on Serum Free Cortisol Fraction and Insulin Concentration in Horses

Hart

Wochele

Norton

et al. 2016

Veterinary Internal Medicne

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“…19 Some medications can have a direct or indirect effect on cortisol levels (eg, digoxin, carbamazepine, and synthetic glucocorticoids) and should also be considered when evaluating the patient's UFC test results. 20 In addition to the test results, it is important to confirm that the patient's 24-hour urine volume and urine creatinine are normal because these values may suggest incomplete or excessive collections. Physicians should confirm adherence to the testing protocol because, on inquiry, patients have often admitted that the collection was done improperly.…”

Section: Urinary Free Cortisolmentioning

confidence: 99%

“…These are palliative treatments because they do not treat the underlying cause or restore normal HPA secretory dynamics. 20 Furthermore, ketoconazole may cause liver damage and requires an acidic pH to be absorbed. Preliminary results following the treatment of patients with CS using the glucocorticoid receptor antagonist mifepristone (RU486; Corcept Therapeutics, Menlo Park, CA) were recently presented at the 2011 Endocrine Society meeting.…”

Section: Medical Therapymentioning

confidence: 99%

Cushing Syndrome: Maybe Not So Uncommon of an Endocrine Disease

Guaraldi¹,

Salvatori²

2012

The Journal of the American Board of Family Medicine

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Background: Cushing syndrome (CS) is the result of extended exposure to excessive glucocorticoids from endogenous or exogenous sources. Traditionally, the most common cause of endogenous CS is a pituitary adenoma (Cushing disease). Less common causes are adrenocortical tumors and extrapituitary adrenocorticotropin-producing neoplasias.Objectives: This review provides updated information regarding the potential for increased prevalence of CS in specific patient populations. Here the authors provide to family physicians clinical guidance for recognition of CS by presenting a case, discussing the advantages/disadvantages of the diagnostic tests, and discussing information about the treatment options.Results: CS is expected to have an incidence of 10 to 15 people per million; however, studies of patients with diabetes, obesity, hypertension, and osteoporosis found a high prevalence of CS among these populations. The clinical manifestations of CS range from the distinctive clinical features (purple striae, facial plethora, proximal myopathy) to common conditions such as hypertension, obesity, and diabetes. Clinical practice guidelines recommend biochemical tests to screen patients for CS; however, the sensitivity and specificity of these tests vary, so a careful analysis must be performed to avoid misdiagnosis.

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“…Another problem of clinical importance is to distinguish CS with pseudo Cushing's states (PCS) related to overactivity of the hypothalamic-pituitary-adrenal axis in patients complaining of depression, visceral obesity, polycystic ovaries syndrome, poorly controlled diabetes, anorexia, menstrual irregularity and chronic alcoholism [8]. On the one hand, depression, diabetes, obesity, hypertension, osteoporosis or menstrual irregularity may constitute symptoms of cortisol excess.…”

Section: Introductionmentioning

confidence: 99%

Diagnostics of hypercortisolism — comparison between the clinical usefulness of salivary and serum cortisol measurements

Żukowski

Myśliwiec²,

Górska³

2013

Endokrynologia Polska

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Introduction: The aim of this study was the comparison of 24h urine free cortisol (UFC), serum cortisol at 11pm (SCM) and late-night salivary cortisol (LSC) in patients suspected for hypercortisolism, and an assessment of the usefulness of these measurements in diagnosing overt Cushing's (OCS) syndrome, pseudo Cushing's state (PCS) and subclinical Cushing's syndrome (SCS). Material and methods:The study group consisted of 82 patients, of whom four patients had SCS, three OCS and eight PCS. For measurements of LSC, the ELISA method was used, and for UFC and SCM determination, chemiluminescent microparticle immunoassay was used.

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Cushing's syndrome

Cited by 1,153 publications

References 147 publications

Effect of Age, Season, Body Condition, and Endocrine Status on Serum Free Cortisol Fraction and Insulin Concentration in Horses

Effect of Age, Season, Body Condition, and Endocrine Status on Serum Free Cortisol Fraction and Insulin Concentration in Horses

Cushing Syndrome: Maybe Not So Uncommon of an Endocrine Disease

Diagnostics of hypercortisolism — comparison between the clinical usefulness of salivary and serum cortisol measurements

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