Subclinical Cushing’s syndrome with bilateral adrenal tumours in a patient with gallbladder multiple stone: therapeutical options

Cârșote, Mara; Ghemigian, Adina; Valea, Ana; Dumitrașcu, Anda; Chirita, Corina; Poiană, Cătălina

doi:10.1515/arsm-2015-0032

Cited by 5 publications

(5 citation statements)

References 26 publications

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“…nelson's syndrome represents another particular situation where aCtH increase is part of the pathogenic loop and its values can get extremely high (22,23,24). this happens after bilateral adrenalectomy for Cushing's disease and it represents a rather atypical option nowadays due to others several medical and surgical therapeutical resources which are preferred (22,25,26). the complication is rare; it involves high aCtH with known complications including the skin,and corticotropinoma enlargement (26,27).…”

Section: Nelson's Syndromementioning

confidence: 99%

Hyperpigmentation and ACTH – an overview of literature

Şandru¹,

Dumitrașcu²,

Albu³

et al. 2019

Ro Med J.

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Hyperpigmentation and aCtH -an overview of literature assist. prof. florica Sandru 1,2 , md, phd, lecturer mihai Cristian dumitrascu 2,3 , md, phd, assist. prof. Simona elena albu 2,3 , md, phd, lecturer mara Carsote 2,4 , md, phd, lecturer ana valea 5,6 , md, phd ABSTRACT Introduction. ACTH (adrenocorticotropic hormone) is a key regulator of adrenal production involving cortisol as an essential hormone for life. The melanin is a pigment which is produced by melanocytes at the level of melanosomes (the melanogenesis). Both MSH and ACTH are generated by the cleavage of POMC (proopiomelanocortin) after CRF (corticotropin-releasing factor) stimulation and then MSH acts on the skin causing hyperpigmentation. Aim. To introduce clinical data of literature that link hyperpigmentation with ACTH excess.

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Section: Nelson's Syndromementioning

confidence: 99%

Hyperpigmentation and ACTH – an overview of literature

Şandru¹,

Dumitrașcu²,

Albu³

et al. 2019

Ro Med J.

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“…The excess of pure adrenal androgens is extremely rare in cases without other secretions and these cases are not usually asymptomatically at presentation so they can barely fit to the diagnosis of adrenal incidentaloma (7,8). The cortisol excess (even subclinical) is more frequent in subjects with bone loss or vertebral fractures (4,9).…”

Section: General Data Adrenal Incidentalomamentioning

confidence: 99%

Osteoporosis and adrenal incidentaloma: To be or not to be?

Şandru¹,

Dumitrașcu²,

Albu³

et al. 2019

Ro J Med Pract.

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Introduction. Adrenal incidentaloma is a more frequent diagnosis during the last decades since the relative access to abdominal ultrasound, computed tomography or magnetic resonance imagery is higher. Aim. Our aim is to focus on the relationship between bone status (BS) in patients diagnosed and confirmed with adrenal incidentaloma. Method. This is a mini-review of the literature. Most of the included papers were published during the last 5 years. The main research tool is PubMed database. General data. BS is affected in adrenal incidentaloma mainly through persistent autonomous cortisol production which is called (even lately the term is not encouraged) "subclinical Cushing's syndrome" with a prevalence of 0.2 up to 2% in unselected series of adult people. TBS (Trabecular Bone Score) in both men and women is negatively correlated with plasma cortisol after 1 mg dexamethasone suppression test. There is 2.2% decrease of TBS if subclinical Cushing's syndrome is confirmed opposite to clear non-functioning pattern of the adrenal incidenaloma. Bone mineral density based on DXA at central sites (lumbar spine and femoral neck) was similar between the subject with unilateral and bilateral incidentaloma. The presence of subliclinical hypercortisolism is positively correlated with a higher risk of osteoporosis and fragility fractures Recently the term of "high risk" patients with adrenal incidentaloma has been introduced in order to describe the subgroup with autonomous cortisol secretion that has an increased risk of cardiovascular morbidities, infections and fractures (even independently of DXA-bone mineral density. Conclusion. The main contributor to BS, as well as to the cardiometabolic damage, remains the autonomous cortisol secretion in adrenal incidentaloma with a potential improvement after adrenalectomy and without a specific anti-osteoporotic medication in this particular situation.

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“…Pasireotide might be a bridge treatment but the complicated diabetes mellitus requiring high doses of daily insulin relatively limits its use (9). Also in this case surgery of the both adrenal glands may become a solution if the control of the disease is not otherwise achieved (10,11,12).…”

Section: Limited Resources For Cushing's Diseasementioning

confidence: 99%

Striae rubrae: Cushing’s syndrome

Valea¹,

Şandru²,

Dumitrașcu³

et al. 2019

Ro J Med Pract.

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Striae rubrae or red striae are found in different circumstances like pregnancy, weight gain and Cushing's syndrome regardless of endogenous or exogenous type. This type of skin lesion is commonly found in general population and usually does not underline a severe condition. The histological aspect that involves the stretch marks is the destruction of the dermal fibbers and their local network. The fibbers have receptors for glucocorticoids. A secondary epidermal anomaly is also seen. In benign scenarios the prevention with topic applications is still a matter of debate while therapy lasers of different types might help. In cases with pathological glucocorticoids excess the removal of the source improves the skin lesions yet not completely, they become white. We aim to introduce two cases of Cushing's disease of different origins to whom impressive red striae were positive from the presentation. Red striae may be the hallmark of Cushing's syndrome in association with different cardio-metabolic and/or bone complications. Despite the remission of the glucocorticoid excess the skin lesions are not completely reversible.

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Subclinical Cushing’s syndrome with bilateral adrenal tumours in a patient with gallbladder multiple stone: therapeutical options

Cited by 5 publications

References 26 publications

Hyperpigmentation and ACTH – an overview of literature

Hyperpigmentation and ACTH – an overview of literature

Osteoporosis and adrenal incidentaloma: To be or not to be?

Striae rubrae: Cushing’s syndrome

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