Cyclic Cushing’s disease with paradoxical response to dexamethasone

2005 ◽  
Vol 28 (10) ◽  
pp. 741-745 ◽  
Author(s):  
S. Checchi ◽  
L. Brilli ◽  
E. Guarino ◽  
C. Ciuoli ◽  
G. Di Cairano ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
Cushing's Disease ◽  
Paradoxical Response

The effect of naloxone on ATCH and β-endorphin in patients with Cushing's disease

1985 ◽  
Vol 110 (2) ◽  
pp. 170-175 ◽  
Author(s):  
B. Baranowska ◽  
W. Dorobek ◽  
W. Misiorowski ◽  
W. Jeske ◽  
M. H. Abdel-Fattah
Keyword(s):  
Cushing’S Disease ◽  
Healthy Subjects ◽  
Opiate Receptor ◽  
Cushing's Disease ◽  
Receptor Blockade ◽  
Acth Secretion ◽  
Endogenous Opiates ◽  
Paradoxical Response ◽  
Cortisol Release ◽  
Serum Acth

Abstract. Endogenous opiates may be important in the control of ACTH secretion in men. The effect of opiate receptor blockade by naloxone on ACTH, β-endorphin-like substance and cortisol release was studied in healthy women and in 9 patients with Cushing's disease. In the healthy subjects, ACTH, β-endorphin and cortisol levels were increased in response to naloxone. However, in 3 our of the 9 patients with Cushing's disease, a paradoxical decrease in serum ACTH, cortisol and β-endorphin concentrations was observed after naloxone administration. In the patients with a paradoxical response to naloxone, transsphenoidal microadenomectomy was ineffective.

scholarly journals Paradoxical response to dexamethasone and spontaneous hypocortisolism in Cushing's disease

2013 ◽  
Vol 2013 (jan29 1) ◽  
pp. bcr2012008035-bcr2012008035 ◽  
Author(s):  
A. R. Lila ◽  
V. Sarathi ◽  
T. R. Bandgar ◽  
N. S. Shah
Keyword(s):  
Cushing’S Disease ◽  
Cushing's Disease ◽  
Paradoxical Response

Cushing's Disease with Periodic Hormonogenesis: One Explanation for Paradoxical Response to Dexamethasone

1973 ◽  
Vol 36 (3) ◽  
pp. 445-451 ◽  
Author(s):  
D. BROWN RONALD ◽  
G. R. VAN LOON ◽  
DAVID. N. ORTH ◽  
GRANT W. LIDDLE
Keyword(s):  
Cushing’S Disease ◽  
Cushing's Disease ◽  
Paradoxical Response

scholarly journals MON-905 A Case of Cushing’s Disease with Glucocorticoid Positive-Feedback

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Hiroki Shichi ◽  
Hidenori Fukuoka ◽  
Yasutaka Tsujimoto ◽  
Masaaki Yamamoto ◽  
Tomoaki Nakamura ◽  
...  
Keyword(s):  
Primary Culture ◽  
Cushing’S Disease ◽  
Positive Feedback ◽  
Ex Vivo ◽  
Culture Method ◽  
Cushing's Disease ◽  
Plasma Acth ◽  
Paradoxical Response ◽  
Free Cortisol ◽  
Underlying Mechanisms

Abstract Background: Although paradoxical response of cortisol (F) during high dose dexamethasone (Dex) suppression test (DST) is observed in a part of ectopic ACTH syndrome, few reports have been shown in Cushing’s disease (CD). It suggests a presence of glucocorticoid (GC)-driven positive-feedback loop. However, the underlying mechanism remains elusive. Here we present a case of CD showing clear clinical and pathophysiological evidences of GC positive-feedback using ex vivo 3-dimensional (D) culture method. Case: A 62-year-old woman manifested typical Cushing’s symptoms, including moon face, central obesity, hypertension, hypokalemia, and vertebral fractures. Endocrinological data were consistent with a diagnosis of CD; morning plasma ACTH 299 pg/mL, serum F 28 μg/dL, midnight serum F 43 μg/dL, and 24hr urinary free cortisol 988 μg/day. CRH test showed a slight increase in plasma ACTH levels (1.4 fold), and pituitary MRI revealed a 14 mm macroadenoma invading into the left cavernous sinus. Interestingly, both 1 mg and 8 mg DST showed a paradoxical increase in serum cortisol levels (27.7→64.7μg/dL and 17.17→35.68μg/dL, respectively). These data indicated a presence of positive-feedback response to GC in the tumor. Indeed, after the initiation of metyrapone (1,000 mg/day) administration for the treatment of hypercortisolemia, plasma ACTH levels were decreased to 147.5 pg/mL accompanied with the decrease in serum F levels to 4.12 μg/dL. Moreover, pituitary tumor obviously shrank during the metyrapone treatment. Thereafter, we undertook transsphenoidal surgery and plasma ACTH and serum F levels decreased to 35.8 pg/mL and 7.6μg/dL, respectively. ex vivo studies: To prove the presence of the positive feedback response and explore the underlying mechanisms, we performed a primary culture experiment using the tumor and applied 3D culture method. The resected tumor tissue was enzymatically digested, dispersed and embedded into the Matrigel. Then cells were treated with Dex (0.1-10 nM), and ACTH concentrations were measured after 72 hrs. Interestingly, ACTH levels significantly increased by 10 nM Dex treatment at 72 h (129 %, p <0.01), indicating a paradoxical response to Dex in the tumor ex vivo. Conclusions: To our knowledge, this is the first case of CD who showed clinically obvious GC positive-feedback that was proved by ex vivo 3D primary culture cell models. Notably, tumor shrinkage was observed during the metyrapone treatment, suggesting that GC positive-feedback mechanisms also involve tumor proliferation. Further investigation is required for elucidating the underlying mechanisms.

Abstract #825 Psychosis in Cushing’s Disease Treated with Etomidate

2018 ◽  
Vol 24 ◽  
pp. 185-186
Author(s):  
Sydney Blount ◽  
Marie Caldwell
Keyword(s):  
Cushing’S Disease ◽  
Cushing's Disease

Abstract #762: Treatment of Recurrent Cushing’s Disease

2005 ◽  
Vol 11 ◽  
pp. 54-55
Author(s):  
Daniel K. Short ◽  
William F. Young
Keyword(s):  
Cushing’S Disease ◽  
Cushing's Disease
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