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1.
Int J Mol Sci ; 22(6)2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33808529

RESUMO

The most known effects of endogenous Cushing's syndrome are the phenotypic changes and metabolic consequences. However, hypercortisolism can exert important effects on other endocrine axes. The hypothalamus-pituitary-thyroid axis activity can be impaired by the inappropriate cortisol secretion, which determinates the clinical and biochemical features of the "central hypothyroidism". These findings have been confirmed by several clinical studies, which also showed that the cure of hypercortisolism can determine the recovery of normal hypothalamus-pituitary-thyroid axis activity. During active Cushing's syndrome, the "immunological tolerance" guaranteed by the hypercortisolism can mask, in predisposed patients, the development of autoimmune thyroid diseases, which increases in prevalence after the resolution of hypercortisolism. However, the immunological mechanism is not the only factor that contributes to this phenomenon, which probably includes also deiodinase-impaired activity. Cushing's syndrome can also have an indirect impact on thyroid function, considering that some drugs used for the medical control of hypercortisolism are associated with alterations in the thyroid function test. These considerations suggest the utility to check the thyroid function in Cushing's syndrome patients, both during the active disease and after its remission.


Assuntos
Síndrome de Cushing/complicações , Síndrome de Cushing/metabolismo , Doenças da Glândula Tireoide/etiologia , Glândula Tireoide/metabolismo , Animais , Síndrome de Cushing/etiologia , Síndrome de Cushing/terapia , Gerenciamento Clínico , Suscetibilidade a Doenças , Glucocorticoides/metabolismo , Humanos , Sistema Hipotálamo-Hipofisário/metabolismo , Transdução de Sinais , Doenças da Glândula Tireoide/diagnóstico , Doenças da Glândula Tireoide/metabolismo , Doenças da Glândula Tireoide/terapia , Testes de Função Tireóidea
3.
Kyobu Geka ; 74(3): 197-201, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33831872

RESUMO

The patient was a woman in her 70's was referred to our hospital because of an abnormal shadow on chest roentgenogram at an annual medical checkup. Since preoperative examinations suggested lung cancer in the right middle lobe, thoracoscopic right middle lobectomy was planned. However, pleural dissemination was detected at surgery and we changed the treatment plan to the intrapleural hyperthermic chemotherapy. During the postoperative course, facial edema, hypokalemia, and hyperglycemia developed, and the diagnosis of Cushing's syndrome was suggested based on an increase in serum level of adrenocorticotropic hormone (ACTH) and cortisol, and was confirmed by a dexamethasone suppression test. Intrapleural hyperthermic chemotherapy was likely to collapse the ACTH-producing tumor leading Cushing's syndrome.


Assuntos
Síndrome de ACTH Ectópico , Tumor Carcinoide , Síndrome de Cushing , Neoplasias Pulmonares , Hormônio Adrenocorticotrópico , Tumor Carcinoide/diagnóstico por imagem , Tumor Carcinoide/terapia , Síndrome de Cushing/diagnóstico por imagem , Síndrome de Cushing/etiologia , Feminino , Humanos , Hidrocortisona , Neoplasias Pulmonares/terapia
4.
Eur J Endocrinol ; 184(4): 565-574, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33730688

RESUMO

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.


Assuntos
Encéfalo/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/etiologia , Imagem por Ressonância Magnética/métodos , Hipersecreção Hipofisária de ACTH/complicações , Adulto , Idoso , Encéfalo/patologia , Mapeamento Encefálico/métodos , Estudos de Casos e Controles , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/patologia , Estudos Transversais , Síndrome de Cushing/complicações , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/epidemiologia , Síndrome de Cushing/patologia , Suscetibilidade a Doenças/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Hipersecreção Hipofisária de ACTH/diagnóstico , Hipersecreção Hipofisária de ACTH/epidemiologia , Hipersecreção Hipofisária de ACTH/patologia , Prevalência
7.
Eur J Endocrinol ; 184(5): R207-R224, 2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33539319

RESUMO

Cushing's syndrome (CS) is associated with increased mortality that is driven by cardiovascular, thromboembolic, and infection complications. Although these events are expected to decrease during disease remission, incidence often transiently increases postoperatively and is not completely normalized in the long-term. It is important to diagnose and treat cardiovascular, thromboembolic, and infection complications concomitantly with CS treatment. Management of hyperglycemia/diabetes, hypertension, hypokalemia, hyperlipidemia, and other cardiovascular risk factors is generally undertaken in accordance with clinical care standards. Medical therapy for CS may be needed even prior to surgery in severe and/or prolonged hypercortisolism, and treatment adjustments can be made based on disease pathophysiology and drug-drug interactions. Thromboprophylaxis should be considered for CS patients with severe hypercortisolism and/or postoperatively, based on individual risk factors of thromboembolism and bleeding. Pneumocystis jiroveci pneumonia prophylaxis should be considered for patients with high urinary free cortisol at the initiation of hypercortisolism treatment.


Assuntos
Doenças Cardiovasculares/epidemiologia , Síndrome de Cushing/epidemiologia , Infecções/epidemiologia , Tromboembolia/prevenção & controle , Adulto , Idoso , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/prevenção & controle , Comorbidade , Síndrome de Cushing/mortalidade , Síndrome de Cushing/cirurgia , Feminino , Humanos , Controle de Infecções , Masculino , Pessoa de Meia-Idade , Pneumocystis carinii , Pneumonia por Pneumocystis/epidemiologia , Pneumonia por Pneumocystis/prevenção & controle , Profilaxia Pré-Exposição , Medição de Risco , Fatores de Risco , Tromboembolia/epidemiologia , Tromboembolia/fisiopatologia
8.
Eur J Endocrinol ; 184(3): 445-454, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33449913

RESUMO

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.


Assuntos
Cortisona/análise , Síndrome de Cushing/diagnóstico , Técnicas de Diagnóstico Endócrino , Cabelo/química , Hidrocortisona/análise , Síndrome de ACTH Ectópico/diagnóstico , Síndrome de ACTH Ectópico/metabolismo , Adenoma/diagnóstico , Adenoma/metabolismo , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/metabolismo , Adulto , Idoso , Estudos de Casos e Controles , Cortisona/metabolismo , Síndrome de Cushing/metabolismo , Síndrome de Cushing/patologia , Feminino , Cabelo/metabolismo , Humanos , Hidrocortisona/metabolismo , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença
9.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495181

RESUMO

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.


Assuntos
Adenoma Hipofisário Secretor de ACT/complicações , Adenoma/complicações , Síndrome de Cushing/etiologia , Hipopotassemia/etiologia , Hipotireoidismo/etiologia , Oclusão da Veia Retiniana/etiologia , Adenoma Hipofisário Secretor de ACT/diagnóstico , Adenoma Hipofisário Secretor de ACT/cirurgia , Adenoma/diagnóstico , Adenoma/cirurgia , Síndrome de Cushing/diagnóstico , Diagnóstico Tardio , Humanos , Hipopotassemia/diagnóstico , Hipofisectomia , Hipotireoidismo/diagnóstico , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Radioterapia , Reoperação , Oclusão da Veia Retiniana/diagnóstico
10.
Eur J Endocrinol ; 184(1): 179-187, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33112275

RESUMO

Objective: Due to the rarity of Cushing's syndrome (CS) in children and adolescents, data are scarce about BMI during active disease and following remission. Therefore, our aim was to analyze BMI after long-term remission and determine predictive factors for promptly identifying patients at risk of being overweight or obese after remission for CS. Design: Retrospective cohort study. Patients: 73 patients: 58 (79.4%) had Cushing disease, 40 males (58%), median age of 12 years (IQR: 9-15). The mean follow-up time was 22.4 ± 18.2 months (range: 4-98). Methods: Main outcome measures: BMI, lipid profile, blood pressure, HOMA-IR. Results: At diagnosis, only eight (11%) patients had a normal weight. Although the BMI z-score at the last follow-up improved (2.0 ± 0.7 to 1.0 ± 1.2, P < 0.001), 44% remained overweight or obese after 2 years of remission according to the Kaplan-Meier curves. The BMI z-scores at the last follow-up correlated only with HOMA-IR levels (r: 0.49, P = 0.027). We found two independent factors related to reaching a normal weight: BMI z-score at diagnosis (HR: 0.156, 95% CI: 0.038-0.644; P = 0.01) and BMI z-score change at 6 ± 2 months (HR: 2.980, 95% CI:1.473-6.028; P = 0.002), which had high accuracy when a cut-off of 0.5 was used for ROC analysis (AUC = 0.828 (0.67-0.97); P < 0.001). Conclusions: Children and adolescents with CS have a high risk of being overweight or obese after successful treatment for their disease. At risk patients can be identified quickly based on their baseline BMI and initial weight loss after surgery. Efforts should focus on adopting healthy diet and lifestyle in the immediate postoperative period.


Assuntos
Síndrome de Cushing/complicações , Sobrepeso/etiologia , Obesidade Pediátrica/etiologia , Adolescente , Adulto , Índice de Massa Corporal , Criança , Estudos de Coortes , Feminino , Humanos , Estimativa de Kaplan-Meier , Lipídeos/sangue , Masculino , Sobrepeso/epidemiologia , Obesidade Pediátrica/epidemiologia , Valor Preditivo dos Testes , Adulto Jovem
12.
Ther Umsch ; 77(9): 441-448, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33146097

RESUMO

Adrenal tumors Abstract. The term 'adrenal tumor' describes benign and malignant mass lesions of the adrenal gland, including primary adrenal tumors and metastases from extra-adrenal origin. With the widespread use of imaging technique, adrenal tumors have become increasingly detected as 'incidentalomas'. The detection of an adrenal tumor raises two questions: Is the mass malignant? Is the mass hormonally active? Whereas the evaluation for malignancy is based on specific imaging characteristics (imaging phenotype), a targeted clinical examination and specific biochemical tests are required to assess for hormonal secretion. An adrenal mass < 4 cm with clear benign features on imaging and with a normal hormonal workup does not require treatment. If malignancy is suspected further diagnostic procedures and / or adrenalectomy are indicated. For hormonally active tumors surgery is generally considered the treatment of choice; however, the decision for surgery has to be individualized for aldosterone-secreting tumors and for cortisol-secreting tumors with only mild cushing's syndrome. Also in patients with large tumors (> 4 cm), and in cases with non-conclusive evaluation for malignancy or hormonal activity, the decision for further management has to be made on an individual basis. A minimally invasive surgical approach may be considered in adrenal tumors < 6 cm and without local infiltration of adjacent structures. Both laparoscopic (transabdominal) and retroperitoneoscopic techniques are possible. The surgical outcome depends on the surgeon's experience. A close interdisciplinary collaboration is mandatory in the evaluation and treatment of adrenal tumors.


Assuntos
Neoplasias das Glândulas Suprarrenais , Síndrome de Cushing , Laparoscopia , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Síndrome de Cushing/cirurgia , Síndrome de Cushing/terapia , Humanos
14.
Radiol Clin North Am ; 58(6): 1099-1113, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33040851

RESUMO

Endocrine disorders associated with adrenal pathologies can be caused by insufficient adrenal gland function or excess hormone secretion. Excess hormone secretion may result from adrenal hyperplasia or hormone-secreting (ie, functioning) adrenal masses. Based on the hormone type, functioning adrenal masses can be classified as cortisol-producing tumors, aldosterone producing tumors, and androgen-producing tumors, which originate in the adrenal cortex, as well as catecholamine-producing pheochromocytomas, which originate in the medulla. Nonfunctioning lesions can cause adrenal gland enlargement without causing hormonal imbalance. Evaluation of adrenal-related endocrine disorders requires clinical and biochemical workup associated with imaging evaluation to reach a diagnosis and guide management.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Síndrome de Cushing/diagnóstico por imagem , Doenças do Sistema Endócrino/diagnóstico por imagem , Feocromocitoma/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/cirurgia , Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/metabolismo , Glândulas Suprarrenais/patologia , Adrenalectomia/métodos , Aldosterona/metabolismo , Androgênios/metabolismo , Síndrome de Cushing/patologia , Doenças do Sistema Endócrino/fisiopatologia , Feminino , Humanos , Hidrocortisona/metabolismo , Masculino , Feocromocitoma/patologia , Prognóstico , Índice de Gravidade de Doença
15.
Artigo em Inglês | MEDLINE | ID: mdl-33071957

RESUMO

Introduction: Italy, since the end of February 2020, is experiencing the corona virus disease 2019 (COVID-19) pandemic that may present as an acute respiratory infection. We report on COVID-19 pneumonia in the context of a complex case of Cushing's disease (CD). Case Report: A 67-year-old man with CD, who was admitted to our hospital, presented with signs and symptoms of adrenal insufficiency with persistent hypotension and glycemia toward the lower limits. We progressively withdrew almost all treatments for diabetes and CD (pasireotide and metyrapone), and i.v. hydrocortisone was necessary. A tendency to hyperkalemia was probably associated to enoxaparin. We summarized the many possible interactions between medications of Cushing's syndrome (CS) and COVID-19. Conclusion: Adrenal insufficiency might be a clinical challenge that needs a prompt treatment also in CS patients during COVID-19 infection. We should consider the possibility to titrate or temporary halt medical therapies of CS in the context of COVID-19 infection. Unexpected hyperkalemia in CS patients under treatment with heparin might be the signal of aldosterone suppression.


Assuntos
Betacoronavirus/efeitos dos fármacos , Infecções por Coronavirus/tratamento farmacológico , Síndrome de Cushing/tratamento farmacológico , Hidrocortisona/uso terapêutico , Metirapona/uso terapêutico , Pneumonia Viral/tratamento farmacológico , Idoso , Anti-Inflamatórios/uso terapêutico , Antimetabólitos/uso terapêutico , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Síndrome de Cushing/complicações , Síndrome de Cushing/virologia , Gerenciamento Clínico , Humanos , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia
16.
Eur J Endocrinol ; 183(6): 669-676, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33112256

RESUMO

Context: Obesity and cardiometabolic diseases are associated with higher long-term glucocorticoid levels, measured as scalp hair cortisol (HairF) and cortisone (HairE). Cardiometabolic diseases have also been associated with copeptin, a stable surrogate marker for the arginine-vasopressin (AVP) system. Since AVP is, together with corticotropin-releasing hormone (CRH) an important regulator of the hypothalamic-pituitary adrenal axis (HPA axis), we hypothesize that AVP contributes to chronic hypercortisolism in obesity. Objective: To investigate whether copeptin levels are associated with Higher HairF and HairE levels in obesity. Design: A cross-sectional study in 51 adults with obesity (BMI ≥30 kg/m2). Methods: Associations and interactions between copeptin, HairF, HairE, and cardiometabolic parameters were cross-sectionally analyzed. Results: Copeptin was strongly associated with BMI and waist circumference (WC) (rho = 0.364 and 0.530, P = 0.008 and <0.001, respectively), also after correction for confounders. There were no associations between copeptin and HairF or HairE on a continuous or dichotomized scale, despite correction for confounders. Conclusion: In patients with obesity, AVP seems not a major contributor to the frequently observed high cortisol levels. Other factors which stimulate the HPA axis or affect cortisol synthesis or breakdown may be more important than the influence of AVP on long-term glucocorticoid levels in obesity.


Assuntos
Cortisona/metabolismo , Síndrome de Cushing/etiologia , Glicopeptídeos/metabolismo , Hidrocortisona/metabolismo , Obesidade/metabolismo , Adulto , Arginina Vasopressina/metabolismo , Biomarcadores/metabolismo , Índice de Massa Corporal , Hormônio Liberador da Corticotropina/metabolismo , Estudos Transversais , Feminino , Glucocorticoides/metabolismo , Cabelo/química , Humanos , Sistema Hipotálamo-Hipofisário/metabolismo , Masculino , Obesidade/complicações , Sistema Hipófise-Suprarrenal/metabolismo
17.
Eur J Endocrinol ; 183(6): K7-K12, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33105102

RESUMO

A monoallelic germline alteration of ARMC5 causes primary bilateral macronodular adrenal hyperplasia (PBMAH) with Cushing's syndrome via its subsequent somatic alteration on the other allele as the second hit. PBMAH is sometimes complicated with meningioma. Dependency of such a multi-organ disease on the second hit mechanism was reported before, but this finding has not been confirmed yet. We describe a case of a 65-year-old female with PBMAH, carrying a heterozygous germline alteration of ARMC5, p.R267*, complicated with meningioma associated with somatic loss of heterozygosity (LOH) of the unaffected allele. Pathogenic alterations of ARMC5 may also contribute to the development of meningioma by the two-hit mechanism.


Assuntos
Proteínas do Domínio Armadillo/genética , Síndrome de Cushing/genética , Neoplasias Meníngeas/genética , Meningioma/genética , Idoso , Alelos , Feminino , Mutação em Linhagem Germinativa/genética , Humanos , Perda de Heterozigosidade/genética
19.
Zhonghua Yi Xue Za Zhi ; 100(36): 2822-2827, 2020 Sep 29.
Artigo em Chinês | MEDLINE | ID: mdl-32988141

RESUMO

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.


Assuntos
Síndrome de Cushing/diagnóstico , Adulto , Sulfato de Desidroepiandrosterona , Diagnóstico Diferencial , Feminino , Humanos , Hidrocortisona , Masculino , Estudos Retrospectivos
20.
Zhonghua Yi Xue Za Zhi ; 100(36): 2828-2833, 2020 Sep 29.
Artigo em Chinês | MEDLINE | ID: mdl-32988142

RESUMO

Objective: To analyze and summarize the clinical characteristics of primary aldosteronism (PA) with concurrent adrenal Cushing's syndrome (ACS). Methods: The clinical, imaging and pathological data of 87 patients with PA admitted to Peking University First Hospital from January 1st, 2013 to December 31th, 2016 were reviewed. There were 45 males (51.7%) and 42 females (48.3%) with an average age of (52.7±10.5) years (range: 15-70 years). According to whether they were diagnosed with ACS, the patients were divided into PA with concurrent ACS group (n=11) and pure PA group (n=55). The clinical characteristics of PA with concurrent ACS were summarized. Results: Ten of the eleven patients in PA with concurrent ACS group were diagnosed with subclinical ACS. Compared with these in pure PA group, the patients in PA with concurrent ACS group were older [(55.6±9.1) years vs (48.4±10.2) years, P=0.033], with larger diameters of adrenal tumors [(2.3±1.6) cm vs (1.4±0.6) cm, P=0.015], higher serum cortisol levels in the circadian rhythm [158 (92, 217) nmol/L vs 71 (43, 128) nmol/L at 0∶00, P=0.004], lower plasma adrenocorticotropic hormone (ACTH) levels in the circadian rhythm [0.80 (<0.22, 1.45) pmol/L vs 4.40 (2.58, 5.93) pmol/L at 8∶00, P<0.001; 0.25 (<0.22, 0.91) pmol/L vs 2.03 (0.74, 3.69) pmol/L at 16∶00, P<0.001;<0.22 (<0.22, 0.44) pmol/L vs 1.27 (<0.22, 2.66) pmol/L at 0∶00, P<0.001], and higher serum cortisol levels after 1 mg overnight dexamethasone suppression test [95 (73, 142) nmol/L vs 30 (22, 41) nmol/L, P<0.001]. Unilateral adrenalectomy was performed in 31 patients, of whom 3 patients in PA with concurrent ACS group (3/8) and 3 patients in pure PA group (3/23) presented with adrenal insufficiency and received glucocorticoid replacement therapy after adrenalectomy. Conclusions: PA with concurrent ACS is not rare in PA patients, which are mainly complicated with subclinical ACS and easily misdiagnosed. It is recommended that elderly PA patients with large adrenal tumors should be screened for ACS by means of cortisol and ACTH circadian rhythm and 1 mg overnight dexamethasone suppression test. Postoperative adrenal insufficiency is prone to occur in those patients, who should be followed up closely after adrenalectomy, and receive glucocorticoid replacement therapy in time.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Síndrome de Cushing/cirurgia , Hiperaldosteronismo , Adolescente , Adrenalectomia , Hormônio Adrenocorticotrópico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
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