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1.
Endocr Pract ; 27(5): 471-477, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33853717

RESUMEN

OBJECTIVE: To examine demographic, clinical, and biochemical differences in patients with adrenocorticotropin (ACTH)-dependent Cushing syndrome (CS) based on etiology, sex, and tumor size. METHODS: This was a single-center study of 211 patients with ACTH-dependent CS followed for 35 years. Patients were stratified into 3 groups based on etiology: Cushing disease (CD)/transsphenoidal surgery, Cushing disease/total bilateral adrenalectomy (CD/TBA), and ectopic ACTH secretion (EAS). Patients were also stratified based on sex and tumor size (nonvisualized, microadenoma, and macroadenoma). RESULTS: CD was the commonest cause of ACTH-dependent CS (190; 90%). Most patients presented in the third decade (median age, 29 years). Clinical features, cortisol, and ACTH were significantly greater in the EAS group. The CD/TBA group had more nonvisualized tumors (22% vs 8%; P = .000) and smaller tumor size (4 vs 6 mm; P = .001) compared with the CD/transsphenoidal surgery group. There was female predominance in CD (2.06:1) and male predominance in EAS (2:1). Men had shorter duration of symptoms (2 years; P = .014), were younger (23 years; P = .001), had lower body mass index (25.1 kg/m2; P = .000), and had more severe disease (low bone mineral density, hypokalemia). Macroadenomas were frequent (46; 24.2%), and ACTH correlated with tumor size in CD (r = 0.226; P = .005). CONCLUSION: Our cohort presented at an earlier age than the Western population with a distinct, but slightly lower, female predilection. Patients with CD undergoing TBA had frequent negative imaging. Men had a clinical profile suggesting aggressive disease. Microadenoma and macroadenoma were difficult to distinguish on a clinicobiochemical basis.


Asunto(s)
Síndrome de ACTH Ectópico , Síndrome de Cushing , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT) , Síndrome de ACTH Ectópico/diagnóstico , Hormona Adrenocorticotrópica , Adulto , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/etiología , Femenino , Humanos , Hidrocortisona , Masculino , Estudios Retrospectivos
2.
Eur J Endocrinol ; 184(4): 565-574, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33730688

RESUMEN

Design: Cushing's disease (CD) is a rare clinical syndrome characterized by chronic exposure to hypercortisolism due to an adrenocorticotropic hormone-secreting pituitary adenoma. The adverse effects of chronic exposure to hypercortisolism on the human brain remain unclear. The purpose of this study was to assess the prevalence of cerebral microbleeds (CMBs) in CD patients and their associations with clinical characteristics. Methods: In this study, 48 active CD patients, 39 remitted CD patients, and 52 healthy control (HC) subjects underwent MRI. CD patients also underwent neuropsychological testing and clinical examinations. The number, locations, and volumes of CMBs were assessed on quantitative susceptibility mapping (QSM) images and with the Microbleed Anatomical Rating Scale. The correlation between CMBs and clinical characteristics was explored. Results: The prevalence of CMBs among active and remitted CD patients was higher than that among HCs (16.3%, 20.5%, and 3.3%, respectively). Moreover, the age of CD patients with CMBs were much younger than HCs with CMBs. Furthermore, the increased number of CMBs in active CD patients was associated with increased cerebrospinal fluid (CSF) volumes in remitted CD patients. Conclusions: Chronic exposure to hypercortisolism may be relevant to CMBs and significantly correlated with altered brain volumes in CD.


Asunto(s)
Encéfalo/diagnóstico por imagen , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/etiología , Imagen por Resonancia Magnética/métodos , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT)/complicaciones , Adulto , Anciano , Encéfalo/patología , Mapeo Encefálico/métodos , Estudios de Casos y Controles , Hemorragia Cerebral/epidemiología , Hemorragia Cerebral/patología , Estudios Transversales , Síndrome de Cushing/complicaciones , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/epidemiología , Síndrome de Cushing/patología , Susceptibilidad a Enfermedades/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT)/diagnóstico , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT)/epidemiología , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT)/patología , Prevalencia
5.
Eur J Endocrinol ; 184(3): 445-454, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33449913

RESUMEN

Objective: Hair cortisol (HF) and cortisone (HE) measurements reflect tissular exposure to cortisol over months and are increased in overt Cushing's syndrome (CS). No data is available in mild CS. We compared the diagnostic performance of HF and HE between patients with overt or mild CS. Design: Single centre retrospective study. Methods: HF&HE were measured by LC-MS/MS in 48 consecutive adult females with Cushing's disease (CD), ectopic ACTH syndrome, secreting adenomas and carcinomas, and adrenal incidentalomas. All had impaired dexamethasone suppression tests. Overt CS (n = 25) was diagnosed in front of specific symptoms, a mean UFC (>1.5 ULN) and increased midnight serum cortisol or salivary cortisol. Mild CS (n = 23) was diagnosed in patients lacking specific symptoms and displaying at least one additional biological abnormality including mildly increased UFC (≤1.5 ULN), increased midnight serum cortisol or salivary cortisol and suppressed plasma ACTH in patients with adrenal tumours. In this study, 84 healthy subjects and obese patients served as controls. Results: HF and HE showed roughly similar performance in overt CS (92 and 100% sensitivity, 91 and 99% specificity, respectively). HF and HE were lower in mild CS but higher than in controls (P < 0.01). HE was correlated with midnight serum cortisol (P < 0.02) and volume of adrenal incidentalomas (P < 0.04) but not with UFC. HF and HE had 59% and 68% sensitivity, and 79 and 94% specificity, respectively, for the diagnosis of mild CS. Contrary to UFC, both HF and HE were in the range of overt CS in 11/23 patients with mild CS. Patients with mild CS and increased HE required more antihypertensive treatments and showed worser lipid profiles than patients with normal HE. Conclusions: HF and HE measurement performed better in overt than in mild CS but is a useful adjunct to diagnose mild CS and to identify adrenocortical incidentalomas responsible for excessive cortisol exposure.


Asunto(s)
Cortisona/análisis , Síndrome de Cushing/diagnóstico , Técnicas de Diagnóstico Endocrino , Cabello/química , Hidrocortisona/análisis , Síndrome de ACTH Ectópico/diagnóstico , Síndrome de ACTH Ectópico/metabolismo , Adenoma/diagnóstico , Adenoma/metabolismo , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/metabolismo , Adulto , Anciano , Estudios de Casos y Controles , Cortisona/metabolismo , Síndrome de Cushing/metabolismo , Síndrome de Cushing/patología , Femenino , Cabello/metabolismo , Humanos , Hidrocortisona/metabolismo , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad
6.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-33495181

RESUMEN

A 53-year-old man presented to his optician with blurring of vision in the right eye and was diagnosed to have branch retinal vein occlusion. Over the following 3 months, he had further progressive visual impairment due to right central retinal vein occlusion (CRVO) and then left CRVO. Soon thereafter, during a hospital admission for infected submandibular gland, he was noted to have secondary hypothyroidism and persistent hypokalaemia which led to the diagnosis of Cushing's syndrome. This case was unusual as the patient did not manifest any classical features of Cushing's syndrome at the time of presentation with bilateral CRVO, and only 3 months later had dramatic weight loss, muscle weakness and acute psychosis. He received intravenous etomidate and underwent emergency transsphenoidal hypophysectomy with dramatic clinical and biochemical improvement and complete visual recovery in the left eye but unfortunately vision in the right eye remained limited to hand movements.


Asunto(s)
Adenoma Hipofisario Secretor de ACTH/complicaciones , Adenoma/complicaciones , Síndrome de Cushing/etiología , Hipopotasemia/etiología , Hipotiroidismo/etiología , Oclusión de la Vena Retiniana/etiología , Adenoma Hipofisario Secretor de ACTH/diagnóstico , Adenoma Hipofisario Secretor de ACTH/cirugía , Adenoma/diagnóstico , Adenoma/cirugía , Síndrome de Cushing/diagnóstico , Diagnóstico Tardío , Humanos , Hipopotasemia/diagnóstico , Hipofisectomía , Hipotiroidismo/diagnóstico , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Radioterapia , Reoperación , Oclusión de la Vena Retiniana/diagnóstico
8.
Zhonghua Yi Xue Za Zhi ; 100(36): 2822-2827, 2020 Sep 29.
Artículo en Chino | MEDLINE | ID: mdl-32988141

RESUMEN

Objective: To evaluate the changes and diagnostic value of serum dehydroepiandrosterone sulfate (DHEAS) in Cushing's syndrome (CS) with different etiologies. Methods: The study retrospectively recruited patients diagnosed as CS in Drum Tower Hospital affiliated to Nanjing University Medical School between January 2012 and June 2019, including 36 patients (8 males, 28 females, with an average age of 44 years) with Cushing disease (CD) and 64 patients (6 males, 58 females, with an average age of 39 years) with adrenal CS (ACS). Meanwhile, 97 patients diagnosed as nonfunctional adrenal adenoma (NFA) were also included as controls. Clinical characteristics, laboratory data, adrenocorticotropic hormone (ACTH), serum DHEAS level and sex-and age-adjusted DHEAS ratio of the three groups were collected. The sensitivity and specificity of DHEAS and its ratio in differential etiology diagnosis of CS were compared using receiver operating characteristic (ROC) curve analysis. Results: Compared to NFA group, ACS patients had lower DHEAS levels [0.39 (0.39, 0.63) µmol/L vs 2.96 (1.92, 4.60) µmol/L, P<0.01] and lower DHEAS ratio [0.58 (0.27, 0.98) vs 3.95 (3.08, 6.83), P<0.01]. DHEAS [6.49 (4.32, 11.63) µmol/L] and DHEAS ratio [9.17 (4.49, 15.41)] in CD patients were significantly higher compared to those in NFA and ACS patients (all P<0.01). There were 53 ACS patients (82.8%) with suppressed ACTH level (<2.2 pmol/L) and 11 patients (17.2%) with normal/high ACTH level (≥2.2 pmol/L). The level of 24 hour urine free cortisol in normal/high ACTH level group was lower than the suppressed ACTH group [(1 299±511) nmol/24 h vs (1 972±876) nmol/24 h, P=0.04]. No significant differences were found in the DHEAS and DHEAS ratio between the two groups. ROC analysis showed that the area under the curve of serum DHEAS and DHEAS ratio in diagnosing ACS from CD was 0.997 and 0.990, respectively. The optimal cut-off values for DHEAS and its ratio were 2.06 µmol/L and 2.10, respectively. The diagnostic sensitivity and specificity of DHEAS were 97.5% and 100%, and those of DHEAS ratio were 95.0% and 100%, respectively. Conclusion: There are significant differences in serum DHEAS level and DHEAS ratio between ACS and CD patients, which might be used as indicators for the identification of the two main CS etiologies, especially in the identification of ACS patients without plasma ACTH suppression from CD patients.


Asunto(s)
Síndrome de Cushing/diagnóstico , Adulto , Sulfato de Deshidroepiandrosterona , Diagnóstico Diferencial , Femenino , Humanos , Hidrocortisona , Masculino , Estudios Retrospectivos
10.
Klin Lab Diagn ; 65(7): 418-423, 2020 Jun 04.
Artículo en Ruso | MEDLINE | ID: mdl-32762179

RESUMEN

Immunochemical methods of analysis are traditionally used for diagnosis of various forms of Cushing's syndrome (CS). In the presence of boundary values of hormonal parameters, doubtful situations, a combination of changes both in pituitary and in adrenal glands, it is useful to determine additional differential diagnostic criteria for the diagnosis of various forms of CS. Urinary steroid profiles (USP) were analyzed by gas chromatography-mass spectrometry (GC-MS) and high-performance liquid chromatography (HPLC) for 38 females with adrenal Cushing's syndrome (CSA), 42 females with pituitary CS (CSP) and 25 healthy females (control group). An increase of free cortisol/free cortisone ratio in the urine (UFF/UFE) for CSP patients in comparison of CSA was obtained by HPLC method. Decreased urinary excretion of UFF and UFE by more than 60% after the 8 mg dexamethasone suppression test had 100% sensitivity and specificity of more than 90% for the diagnosis of CSP. GC-MS method in patients with CSA and CSG revealed the peculiarities of androgens, progestins and glucocorticoids metabolism which leaded to obtain specific USP for CS of different genesis. Increased urinary excretions of dehydroepiandrosterone and its metabolites, metabolites of androstenedione, the ratio of sum of cortisol and cortisone tetrahydrometabolites to tetrahydro-11-deoxycortisol (more then 36) in CSP patients compared with CSA are additional signs for differential diagnosis of these diseases. The combination of classical tests and USP obtained by HPLC and GC-MS methods increased the sensitivity and specificity of differential diagnosis of CSA and CSP.


Asunto(s)
Cromatografía Líquida de Alta Presión , Cortisona , Síndrome de Cushing , Cortisona/análisis , Síndrome de Cushing/diagnóstico , Dexametasona , Diagnóstico Diferencial , Femenino , Cromatografía de Gases y Espectrometría de Masas , Humanos , Hidrocortisona
11.
Arch. argent. pediatr ; 118(3): e278-e283, jun. 2020. ilus, tab
Artículo en Español | LILACS, BINACIS | ID: biblio-1116944

RESUMEN

El incremento de la expectativa de vida con el advenimiento de la terapia antirretroviral de alta eficacia plantea desafíos en cuanto a la toxicidad e interacciones medicamentosas. El síndrome de Cushing exógeno por interacción entre ritonavir y fluticasona inhalada en niños con diagnóstico de infección por virus de la inmunodeficiencia humana y patología pulmonar crónica es infrecuente. Hasta el momento, hay 20 casos reportados. Se describen 3 casos pediátricos con diagnóstico de infección por virus de la inmunodeficiencia humana y patología pulmonar crónica que presentaron síndrome de Cushing exógeno con fluticasona inhalada en dosis habituales por la interacción medicamentosa entre esta y ritonavir. Los pacientes resolvieron el cuadro clínico luego de 2-4 meses de suspensión de la fluticasona y permanecieron asintomáticos en el seguimiento


The increase in life expectancy with the advent of highly effective antiretroviral therapy poses challenges in terms of toxicity and drug interactions. Exogenous Cushing syndrome by interaction between ritonavir and inhaled fluticasone in children diagnosed with human immunodeficiency virus infection and chronic pulmonary pathology is rare. So far, there are 20 cases reported. Three pediatric cases are reported, with a diagnosis of human immunodeficiency virus infection and chronic pulmonary pathology who presented exogenous Cushing syndrome with inhaled fluticasone at usual doses due to drug interaction between it and ritonavir. The patients resolved the clinical Síndrome de Cushing exógeno por interacción medicamentosa de ritonavir y fluticasona inhalada. Reporte de tres casos pediátricos Exogenous Cushing syndrome due to drug interaction of ritonavir and inhaled fluticasone. Report of three pediatric cases picture after 2-4 months of fluticasone suspension and remain asymptomatic in the follow-up.


Asunto(s)
Humanos , Masculino , Niño , Adolescente , Síndrome de Cushing/diagnóstico , VIH , Ritonavir/uso terapéutico , Síndrome de Cushing/terapia , Fluticasona/efectos adversos , Fluticasona/uso terapéutico , Enfermedades Pulmonares
12.
Praxis (Bern 1994) ; 109(7): 531-538, 2020.
Artículo en Alemán | MEDLINE | ID: mdl-32456577

RESUMEN

CME: Endogenous Hypercortisolism (Endogenous Cushing's Syndrome) Abstract. Endogenous Cushing's syndrome (eCS) represents a rare disease entity. At the beginning symptoms and signs often are non-specific. However, untreated eCS is associated with a substantial morbidity and mortality rate. This article provides an actual overview about the etiology, clinical presentation and diagnosis of eCS with special focus on specific screening tests.


Asunto(s)
Síndrome de Cushing , Síndrome de Cushing/diagnóstico , Humanos , Hidrocortisona
13.
Eur J Endocrinol ; 183(1): G1-G7, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32380475

RESUMEN

Clinical evaluation should guide those needing immediate investigation. Strict adherence to COVID-19 protection measures is necessary. Alternative ways of consultations (telephone, video) should be used. Early discussion with regional/national experts about investigation and management of potential and existing patients is strongly encouraged. Patients with moderate or severe clinical features need urgent investigation and management. Patients with active Cushing's syndrome, especially when severe, are immunocompromised and vigorous adherence to the principles of social isolation is recommended. In patients with mild features or in whom a diagnosis is less likely, clinical re-evaluation should be repeated at 3 and 6 months or deferred until the prevalence of SARS-CoV-2 has significantly decreased; however, those individuals should be encouraged to maintain social distancing. Diagnostic pathways may need to be very different from usual recommendations in order to reduce possible exposure to SARS-CoV-2. When extensive differential diagnostic testing and/or surgery is not feasible, it should be deferred and medical treatment should be initiated. Transsphenoidal pituitary surgery should be delayed during high SARS-CoV-2 viral prevalence. Medical management rather than surgery will be the used for most patients, since the short- to mid-term prognosis depends in most cases on hypercortisolism rather than its cause; it should be initiated promptly to minimize the risk of infection in these immunosuppressed patients. The risk/benefit ratio of these recommendations will need re-evaluation every 2-3 months from April 2020 in each country (and possibly local areas) and will depend on the local health care structure and phase of pandemic.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Síndrome de Cushing/terapia , Inhibidores Enzimáticos/uso terapéutico , Glucocorticoides/uso terapéutico , Control de Infecciones/métodos , Procedimientos Neuroquirúrgicos/métodos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Telemedicina , Inhibidores de 14 alfa Desmetilasa/uso terapéutico , Adenoma Hipofisario Secretor de ACTH/complicaciones , Adenoma Hipofisario Secretor de ACTH/diagnóstico , Adenoma Hipofisario Secretor de ACTH/terapia , Adenoma/complicaciones , Adenoma/diagnóstico , Adenoma/terapia , Infecciones por Coronavirus/transmisión , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/etiología , Síndrome de Cushing/inmunología , Manejo de la Enfermedad , Humanos , Hidrocortisona/sangre , Huésped Inmunocomprometido , Cetoconazol/uso terapéutico , Metirapona/uso terapéutico , Educación del Paciente como Asunto , Neumonía Viral/transmisión , Guías de Práctica Clínica como Asunto , Índice de Severidad de la Enfermedad , Factores de Tiempo
17.
Best Pract Res Clin Endocrinol Metab ; 34(2): 101380, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32165101

RESUMEN

Cushing's syndrome (CS) is a severe condition that results from chronic exposure to elevated circulating cortisol levels; it is a rare but potentially life-threating condition, especially when not timely diagnosed and treated. Even though the diagnosis can be straightforward in florid cases due to their typical phenotype, milder forms can be missed. Despite the availability of different screening tests, the diagnosis remains challenging as none of the available tools proved to be fully accurate. Due to the ubiquitous effect of cortisol, it is easy understandable that its excess leads to a variety of systemic complications including hypertension, metabolic syndrome, bone damages and neurocognitive impairment. This article discusses clinical presentation of CS with an eye on the most frequent cortisol-related comorbidities and discuss the main pitfalls of first- and second-line tests in endogenous hypercortisolism diagnostic workup.


Asunto(s)
Síndrome de Cushing/complicaciones , Síndrome de Cushing/diagnóstico , Técnicas de Diagnóstico Endocrino , Comorbilidad , Síndrome de Cushing/epidemiología , Diagnóstico Diferencial , Técnicas de Diagnóstico Endocrino/tendencias , Humanos , Hidrocortisona/metabolismo , Hipertensión/diagnóstico , Hipertensión/epidemiología , Hipertensión/etiología , Síndrome Metabólico/diagnóstico , Síndrome Metabólico/epidemiología , Síndrome Metabólico/etiología
18.
Best Pract Res Clin Endocrinol Metab ; 34(2): 101382, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32139169

RESUMEN

Pituitary surgery is the first-line treatment for patients with Cushing's disease. For patients who are not considered candidates for pituitary surgery, pituitary radiation and bilateral adrenalectomy are further treatment alternatives. Not all patients are cured with pituitary surgery, and a substantial number of patients develop recurrence, sometimes many years after an apparently successful treatment. The same applies to patients treated with radiotherapy. Far from all patients are cured, and in many cases the disease recurs. Bilateral adrenalectomy, although always curative, causes chronic adrenal insufficiency and the remaining pituitary tumour can continue to grow and cause symptoms due to pressure on adjacent tissues, a phenomenon called Nelson's syndrome. In this paper the rate of recurrence of hypercortisolism, as well as the rate of development of Nelson's syndrome, following treatment of patients with Cushing's syndrome, will be reviewed. The aim of the paper is also to summarize clinical and biochemical factors that are associated with recurrence of hypercortisolism and how the patients should be monitored following treatment.


Asunto(s)
Biomarcadores/análisis , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/terapia , Diagnóstico por Imagen/métodos , Técnicas de Diagnóstico Endocrino , Monitoreo Fisiológico/métodos , Enfermedad de Addison/diagnóstico , Enfermedad de Addison/epidemiología , Enfermedad de Addison/etiología , Enfermedad de Addison/terapia , Adenoma/complicaciones , Adenoma/diagnóstico , Adenoma/epidemiología , Adenoma/terapia , Adrenalectomía/efectos adversos , Síndrome de Cushing/epidemiología , Síndrome de Cushing/patología , Humanos , Síndrome de Nelson/diagnóstico , Síndrome de Nelson/epidemiología , Síndrome de Nelson/etiología , Síndrome de Nelson/cirugía , Neoplasias Hipofisarias/complicaciones , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/epidemiología , Neoplasias Hipofisarias/terapia , Recurrencia
19.
Eur J Endocrinol ; 182(6): 569-582, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32213657

RESUMEN

Objective: The challenge of diagnosing Cushing's syndrome (CS) calls for high precision biochemical screening. This study aimed to establish robust reference intervals for, and compare the diagnostic accuracy of, salivary cortisol and cortisone in late-night samples and after a low-dose (1 mg) dexamethasone suppression test (DST). Design and methods: Saliva samples were collected at 08:00 and 23:00 h, and at 08:00 h, after a DST, from 22 patients with CS and from 155 adult reference subjects. We also collected samples at 20:00 and 22:00 h from 78 of the reference subjects. Salivary cortisol and cortisone were analysed with liquid chromatography-tandem mass spectrometry. The reference intervals were calculated as the 2.5th and 97.5th percentiles of the reference population measurements. Diagnostic accuracies of different tests were compared, based on areas under the receiver-operating characteristic curves. Results: The upper reference limits of salivary cortisol and cortisone at 23:00 h were 3.6 nmol/L and 13.5 nmol/L, respectively. Using these reference limits, CS was detected with a sensitivity (95% CI) of 90% (70-99%) and specificity of 96% (91-98%) for cortisol, and a 100% (84-100%) sensitivity and 95% (90-98%) specificity for cortisone. After DST, cortisol and cortisone upper reference limits were 0.79 nmol/L and 3.5 nmol/L, respectively. CS was detected with 95% (75-100%) sensitivity and 96% (92-99%) specificity with cortisol, and 100% (83-100%) sensitivity and 94% (89-97%) specificity with cortisone. No differences in salivary cortisol or cortisone levels were found between samples collected at 22:00 and 23:00 h. Conclusion: Salivary cortisol and cortisone in late-night samples and after DST showed high accuracy for diagnosing CS, salivary cortisone being slightly, but significantly better.


Asunto(s)
Cortisona/análisis , Síndrome de Cushing/diagnóstico , Hidrocortisona/análisis , Tamizaje Masivo/estadística & datos numéricos , Saliva/química , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Ritmo Circadiano , Dexametasona , Femenino , Humanos , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Curva ROC , Valores de Referencia , Sensibilidad y Especificidad , Espectrometría de Masas en Tándem , Factores de Tiempo , Adulto Joven
20.
Biosens Bioelectron ; 154: 112071, 2020 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-32056965

RESUMEN

In the neuroendocrine system, corticotropin-releasing hormone (CRH) and adrenocorticotropic hormone (ACTH) play important roles in the regulation of the hypothalamic-pituitary-adrenal (HPA) system. Disorders of the HPA system lead to physiological problems, such as Addison's disease and Cushing's syndrome. Therefore, detection of CRH and ACTH is essential for diagnosing disorders related to the HPA system. Herein, receptors of the HPA axis were used to construct a bioelectronic sensor system for the detection of CRH and ACTH. The CRH receptor, corticotropin-releasing hormone receptor 1 (CRHR1), and the ACTH receptor, melanocortin 2 receptor (MC2R), were produced using an Escherichia coli expression system, and were reconstituted using nanodisc (ND) technology. The receptor-embedded NDs were immobilized on a floating electrode of a carbon nanotube field-effect transistor (CNT-FET). The constructed sensors sensitively detected CRH and ACTH to a concentration of 1 fM with high selectivity in real time. Furthermore, the reliable detection of CRH and ACTH in human plasma by the developed sensors demonstrated their potential in clinical and practical applications. These results indicate that CRHR1 and MC2R-based bioelectronic sensors can be applied for rapid and efficient detection of CRH and ACTH.


Asunto(s)
Hormona Adrenocorticotrópica/aislamiento & purificación , Técnicas Biosensibles , Hormona Liberadora de Corticotropina/aislamiento & purificación , Sistema Hipotálamo-Hipofisario/metabolismo , Enfermedad de Addison/diagnóstico , Enfermedad de Addison/genética , Hormona Adrenocorticotrópica/química , Hormona Liberadora de Corticotropina/química , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/genética , Humanos , Hidrocortisona/química , Hidrocortisona/genética , Sistema Hipófiso-Suprarrenal/metabolismo , Receptor de Melanocortina Tipo 2/química , Receptor de Melanocortina Tipo 2/genética , Receptores de Corticotropina/química , Receptores de Corticotropina/genética , Receptores de Hormona Liberadora de Corticotropina/química , Receptores de Hormona Liberadora de Corticotropina/genética
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