The diagnosis of Cushing’s syndrome

Carroll, Ty B.; Findling, James W.

doi:10.1007/s11154-010-9143-3

Cited by 74 publications

(31 citation statements)

References 50 publications

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“…Circadian regulation of GC secretion from the adrenal gland plays an important role in the regulation of energy metabolism. For example, excess of cortisol leads to hyperglycemia, hypertension, sleep disturbance, body weight gain and other metabolic impairments (Carroll and Findling, 2010). GC signaling is critical for maintaining fasting glucose by stimulating hepatic gluconeogenesis (Lin and Accili, 2011).…”

Section: Glucocorticoid Rhythmmentioning

confidence: 99%

Circadian rhythms in glucose and lipid metabolism in nocturnal and diurnal mammals

Jha

Challet

Kalsbeek

2015

Molecular and Cellular Endocrinology

189

129

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a b s t r a c tMost aspects of energy metabolism display clear variations during day and night. This daily rhythmicity of metabolic functions, including hormone release, is governed by a circadian system that consists of the master clock in the suprachiasmatic nuclei of the hypothalamus (SCN) and many secondary clocks in the brain and peripheral organs. The SCN control peripheral timing via the autonomic and neuroendocrine system, as well as via behavioral outputs. The sleepewake cycle, the feeding/fasting rhythm and most hormonal rhythms, including that of leptin, ghrelin and glucocorticoids, usually show an opposite phase (relative to the lightedark cycle) in diurnal and nocturnal species. By contrast, the SCN clock is most active at the same astronomical times in these two categories of mammals. Moreover, in both species, pineal melatonin is secreted only at night. In this review we describe the current knowledge on the regulation of glucose and lipid metabolism by central and peripheral clock mechanisms. Most experimental knowledge comes from studies in nocturnal laboratory rodents. Nevertheless, we will also mention some relevant findings in diurnal mammals, including humans. It will become clear that as a consequence of the tight connections between the circadian clock system and energy metabolism, circadian clock impairments (e.g., mutations or knock-out of clock genes) and circadian clock misalignments (such as during shift work and chronic jet-lag) have an adverse effect on energy metabolism, that may trigger or enhancing obese and diabetic symptoms.

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Section: Glucocorticoid Rhythmmentioning

confidence: 99%

Circadian rhythms in glucose and lipid metabolism in nocturnal and diurnal mammals

Jha

Challet

Kalsbeek

2015

Molecular and Cellular Endocrinology

189

129

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“…GC disruption is associated with a variety of disorders. Cushing's disease is characterized by excess cortisol, with symptoms including hypertension, hyperglycemia, sleep disorders, depression, and weight gain (Carroll & Findling 2010). Addison's disease, characterized by a lack of cortisol, is accompanied by symptoms of weight loss, elevated sensitivity to stress, hypotension, mood disorders, and hypoglycemia (Mitchell & Pearce 2012).…”

Section: Cortisolmentioning

confidence: 99%

Interactions between endocrine and circadian systems

Tsang¹,

Barclay

Oster

2013

Journal of Molecular Endocrinology

101

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In most species, endogenous circadian clocks regulate 24-h rhythms of behavior and physiology. Clock disruption has been associated with decreased cognitive performance and increased propensity to develop obesity, diabetes, and cancer. Many hormonal factors show robust diurnal secretion rhythms, some of which are involved in mediating clock output from the brain to peripheral tissues. In this review, we describe the mechanisms of clock-hormone interaction in mammals, the contribution of different tissue oscillators to hormonal regulation, and how changes in circadian timing impinge on endocrine signalling and downstream processes. We further summarize recent findings suggesting that hormonal signals may feed back on circadian regulation and how this crosstalk interferes with physiological and metabolic homeostasis.

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“…During the past almost three decades, the measurement of salivary cortisol has become indispensable in the evaluation of patients with Cushing's syndrome. Since this topic has been extensively reviewed [1][2][3][4][5][6][7][8][9][10], this review will focus on the types of assays available to the practicing clinician and provide a rational approach to their use and interpretation of the results.…”

Section: Introductionmentioning

confidence: 99%

Cushing’s syndrome: diagnosis and surveillance using salivary cortisol

Raff

2011

Pituitary

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This short review summarizes the use of late-night salivary cortisol measurement in the diagnosis of Cushing's syndrome, in the evaluation of patients with adrenal incidentalomas, and in monitoring of post-operative patients, with a focus on the different assay methodologies currently in common use. The focus is on recent studies identified by literature searches using Ovid Medline and Google Scholar as well as analysis of several recent review articles on the topic. Measurement of late night salivary cortisol (LNSC) has an excellent sensitivity and specificity for the diagnosis of Cushing's syndrome regardless of the assay methodology used. Immunoassays have the advantage of simplicity, low cost, and small sample volume requirement, while liquid chromatography-tandem mass spectrometry has the advantage of a high specificity for cortisol and the ability to measure cortisone. The overnight dexamethasone suppression test appears to be superior to LNSC measurement in the evaluation of patients with adrenal incidentalomas. LNSC measurement is an excellent approach to monitor post-operative Cushing's disease patients for surgical failure or recurrence. Salivary cortisol is most useful as the initial test when Cushing's syndrome is suspected and for periodic patient monitoring after pituitary surgery for Cushing's disease.

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The diagnosis of Cushing’s syndrome

Cited by 74 publications

References 50 publications

Circadian rhythms in glucose and lipid metabolism in nocturnal and diurnal mammals

Circadian rhythms in glucose and lipid metabolism in nocturnal and diurnal mammals

Interactions between endocrine and circadian systems

Cushing’s syndrome: diagnosis and surveillance using salivary cortisol

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