Cushing's syndrome: update on signs, symptoms and biochemical screening

Abstract

Endogenous pathologic hypercortisolism, or Cushing’s syndrome, is associated with poor quality of life, morbidity and increased mortality. Early diagnosis may mitigate against this natural history of the disorder. The clinical presentation of Cushing’s syndrome varies, in part related to the extent and duration of cortisol excess. When hypercortisolism is severe, its signs and symptoms are unmistakable. However, most of the signs and symptoms of Cushing’s syndrome are common in the general population (e.g. hypertension and weight gain) and not all are present in every patient. In addition to classical features of glucocorticoid excess, such as proximal muscle weakness and wide purple striae, patients may present with the associated co-morbidities that are caused by hypercortisolism. These include cardiovascular disease, thromboembolic disease, psychiatric and cognitive deficits, and infections. As a result, internists and generalists must consider Cushing’s syndrome as a cause, and endocrinologists should search for and treat these co-morbidities. Recommended tests to screen for Cushing’s syndrome include 1 mg dexamethasone suppression, urine free cortisol and late night salivary cortisol. These may be slightly elevated in patients with physiologic hypercortisolism, which should be excluded, along with exogenous glucocorticoid use. Each screening test has caveats and the choice of tests should be individualized based on each patient’s characteristics and lifestyle. The objective of this review was to update the readership on the clinical and biochemical features of Cushing’s syndrome that are useful when evaluating patients for this diagnosis.

Lack of association between clinical signs and laboratory parameters in dogs with hyperadrenocorticism before and during trilostane treatment

“…Further, in our study, owners were not aware of their answers to the previous questionnaires, which could, however, have helped them to assess the improvement of clinical signs between the first and further rechecks. On the other hand, clinical signs might not only be related to the extent but also to the duration of cortisol excess, a phenomenon which has been documented in human medicine (Nieman, 2015). Finally, timing of the ACTH-stimulation test in relation to trilostane administration has an influence on the magnitude of the cortisol concentration and stimulation, which in turn could lead to a lack of correlation between clinical signs and cortisol concentrations.…”

Fractionated CO2 Laser in the Treatment of Striae Alba in Darker Skinned Patients - A Prospective Study

“…They often emerge on different parts of athletes' body, on the breasts and abdomen of pregnant women, in teenagers during the peak of their growth, and in over weighted people. [5][6][7][8] Etiologic factors of striae have not been completely revealed. Skin stretch may result in explosive degranulation of mast cells with consequent destruction of elastin and collagen fibers.…”

“…9 Cushing syndrome or long term administration of topical/oral corticosteroids may cause the developing of striae. 5,[10][11][12][13] Genetic susceptibility can definitely have a major role as well; however, the precise mechanism has not completely elucidated. Tung et al performed some accurate genome analysis and demonstrated the collapse of elastic microfibrils as the etiology of some cases of striae distensae.…”

Análise da expressão da filamina A nos tumores hipofisários e suas implicações clínicas e terapêuticas

“…Para estabelecer o diagnóstico da Síndrome de Cushing são necessários ao menos dois de três testes alterados (118) .…”

“…Em radioimunoensaios convencionais, o valor de dosagem de ACTH utilizado para essa distinção é de 10 ng/L (118)(119)(120) . Confirmado o hipercortisolismo ACTH dependente, a avaliação hipofisária com ressonância magnética de hipófise é realizada.…”