Cyclic Cushing’s Syndrome – A Diagnostic Challenge

Świątkowska−Stodulska, Renata; Berlińska, Agata; Stefańska, Katarzyna; Kłosowski, Przemysław; Sworczak, Krzysztof

doi:10.3389/fendo.2021.658429

Cited by 15 publications

(19 citation statements)

References 55 publications

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“…There are many studies that evaluate hair cortisol as a useful tool in the assessment of Cushing’s syndrome 31 , cyclic Cushing’s syndrome 32 , depression 33 , maternal stress during pregnanacy 34 , as well as in the follow-up of patients with adrenal insufciency treated with hydrocortisone 35 . More recently, it has been shown that hair cortisol results an interesting biomarker of stress and burnout in a health workers population 23 .…”

Section: Discussionmentioning

confidence: 99%

Hair cortisol in polycystic ovary syndrome

González

Maidana

Ibar

et al. 2022

Sci Rep

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The aim of the study was to evaluate adrenal axis hyperactivation measuring hair cortisol levels, and its influence on the relationship among metabolic parameters, inflammation markers and androgens in adult women with PCOS. 44 women (18–34 years) with PCOS diagnosis and a control group of 49 healthy women (19–35 years) were included. In both gropus body mass index (BMI) was calculated and waist circumference (WC) was measured. Hair cortisol, total serum testosterone (TT), serum cortisol, 25 OH vitamin D (25OHD), insulin, high sensitivity C-reactive protein (hsCRP), triglycerides (TG), HDL cholesterol (HDL), glucose and leptin were measured. Bioavailable testosterone (bioT) was calculated. Hair cortisol concentration was higher and significantly different in PCOS patients compared to the control group (130 vs 63 pg/mg of hair, p < 0.001). Subsequently, patients with PCOS were divided into two groups according to hair cortisol levels: group 1 with normal hair cortisol concentration and group 2 with levels above the upper limit of the reference values (128 pg/mg of hair). In group 2, TT significantly correlated with 25OHD, hsCRP, TG/HDL index, BMI, WC, insulin and HOMA (p < 0.05); bioT correlated with hsCRP and leptin (p < 0.05). Finally, 25OHD was inversely correlated with leptin and with TG/HDL index (p < 0.05). High hair cortisol concentration in patients with PCOS confirmed hyperactivation of the HPA axis. The associations observed were only found in patients with PCOS with high hair cortisol levels (> 128 pg/mg of hair), showing a possible effect of HPA axis in these associations.

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Section: Discussionmentioning

confidence: 99%

Hair cortisol in polycystic ovary syndrome

González

Maidana

Ibar

et al. 2022

Sci Rep

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“…However, certain conditions, such as for example severe illness, active alcoholism, or pregnancy, can trigger excess cortisol production and non-responsiveness to the normal physiological stimuli known as non-neoplastic hypercortisolemia [ 16 , 17 , 18 ]. Rare conditions, such as, for example, intermittent hypercortisolemia, can result in surges of cortisol which can be difficult to capture in standard evaluation [ 19 ]. In the GCG group, full suppression of cortisol secretion in any of the three time points was not as widespread as one might expect despite the supraphysiological doses of administered glucocorticoids.…”

Section: Discussionmentioning

confidence: 99%

Cortisol as an Independent Predictor of Unfavorable Outcomes in Hospitalized COVID-19 Patients

Świątkowska−Stodulska

Berlińska

Puchalska-Reglińska³

2022

Biomedicines

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Most cases of COVID-19 are non-severe, but some patients require urgent hospital care. In the past, it has been established that adrenal hyperactivity predicts poorer prognosis in severely ill patients. We wanted to verify if cortisol levels can be tied to clinical outcomes and the degree of inflammation in hospitalized COVID-19 patients. We recruited 180 adult patients with PCR-confirmed COVID-19. The group was divided into smaller subgroups based on the glucocorticoid treatment status; the subgroups were evaluated in three separate time points. The assessment involved hormonal function (cortisol, ACTH), inflammatory markers, and occurrence of the pre-selected endpoints (death, hospitalization ≥10 days, non-invasive ventilation or high-flow oxygenation, mechanical ventilation, vasopressors). In the evaluated group, 121 patients showed signs of abnormal adrenal function. There was a clear correlation between cortisol and IL-6 concentrations in all three time points regardless of glucocorticoid treatment. A total of 71.1% of patients displaying abnormal cortisol production met the preselected endpoints. Our analysis showed that a cutoff cortisol concentration prognosing endpoint occurrence could be set at 15.45 μg/dL for patients not treated with glucocorticoids. Cortisol concentration can be seen as an independent prognostic factor for unfavorable outcomes in selected adults hospitalized with COVID-19.

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“…Another alternative developed over the past few years involves the measurement of cortisol in hair obtained from the scalp. Measurement of hair cortisol has the advantage of assessing cumulative cortisol levels retrospectively, for periods ranging from one month to years depending on the hair length, and therefore could be very helpful in the establishment of diagnosis of CS in cases of cyclicity 51 . Cortisol is measured either with immunoassays or with the more accurate LCMS, but the technique is yet only available in specific centres, each of which has its own cutoff values for distinguishing between normal and elevated cortisol levels 17,18 …”

Section: Diagnostic Pitfalls and Confounding Conditionsmentioning

confidence: 99%

Diagnostic workup of Cushing’s syndrome

Balomenaki

Margaritopoulos

Vassiliadi

et al. 2022

J Neuroendocrinology

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Cushing's syndrome (CS) is a rare but detrimental endocrine disorder. Early diagnosis and prompt treatment are essential since the duration of hypercortisolism has an adverse impact on the extent of comorbidities and overall survival. The diagnostic approach involves a stepwise process that includes (1) screening and confirming the diagnosis and (2) establishing the aetiology of CS. The tests currently used to confirm the diagnosis of CS include urinary free cortisol measurements, the dexamethasone suppression test and late‐ night salivary cortisol or midnight serum cortisol measurements. None of these tests are ideal; all have pitfalls and require careful interpretation. Following confirmation of CS, measurement of ACTH discriminates between ACTH‐dependent and non‐ACTH dependent causes of CS. Adrenal imaging provides clues for the aetiology of non‐ACTH dependent forms. Differentiation between the ACTH‐dependent forms that involve pituitary corticotroph adenomas and ectopic ACTH sources is more complex and include pituitary MRI imaging, the high dose dexamethasone suppression test, the CRH test, bilateral inferior petrosal sinus sampling and, when required imaging modalities to detect ectopic ACTH secreting lesions. This review, which is part of a special issue on "Update of Cushing's syndrome: 100 years after Minnie G" will provide an update on our current diagnostic workup for the confirmation and differential diagnosis of CS.

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Cyclic Cushing’s Syndrome – A Diagnostic Challenge

Cited by 15 publications

References 55 publications

Hair cortisol in polycystic ovary syndrome

Hair cortisol in polycystic ovary syndrome

Cortisol as an Independent Predictor of Unfavorable Outcomes in Hospitalized COVID-19 Patients

Diagnostic workup of Cushing’s syndrome

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