Editorial Comment to Adrenalectomy in Japanese patients with subclinical Cushing syndrome: 1‐mg dexamethasone suppression test to predict the surgical benefit

2020 ◽  
Author(s):  
Shigeto Ishidoya
Keyword(s):  
Editorial Comment ◽  
Cushing Syndrome ◽  
Japanese Patients ◽  
Dexamethasone Suppression Test ◽  
Suppression Test ◽  
Subclinical Cushing Syndrome ◽  
Subclinical Cushing ◽  
Dexamethasone Suppression

Intravenous dexamethasone suppression test in cushing syndrome diagnosis: Three cases

2020 ◽  
Author(s):  
Urcan Ince ◽  
Cevdet Aydin ◽  
Deryol Hilal Yildirim ◽  
Nagihan Bestepe ◽  
Oya Topaloglu ◽  
...  
Keyword(s):  
Cushing Syndrome ◽  
Dexamethasone Suppression Test ◽  
Syndrome Diagnosis ◽  
Suppression Test ◽  
Dexamethasone Suppression

Performance of the 4-mg intravenous dexamethasone suppression test in differentiating Cushing disease from pseudo-Cushing syndrome

2016 ◽  
Vol 77 (1) ◽  
pp. 30-36 ◽  
Author(s):  
Migueline Nouvel ◽  
Muriel Rabilloud ◽  
Véronique Raverot ◽  
Fabien Subtil ◽  
Julien Vouillarmet ◽  
...  
Keyword(s):  
Cushing Syndrome ◽  
Dexamethasone Suppression Test ◽  
Cushing Disease ◽  
Suppression Test ◽  
Dexamethasone Suppression

scholarly journals Incidence of Venous Thromboembolic Events in Patients With Endogenous Cushing Syndrome

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A86-A87
Author(s):  
Karthik Subbu ◽  
Zunera Tariq ◽  
Dana Z Erickson ◽  
Irina Bancos ◽  
Diane Donegan
Keyword(s):  
Cushing Syndrome ◽  
Dexamethasone Suppression Test ◽  
Thromboembolic Events ◽  
Increased Risk ◽  
Free Cortisol ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Suppression Test ◽  
Clinically Significant ◽  
Dexamethasone Suppression

Abstract Background: Hypercortisolemia is a hypercoagulable state associated with increased risk of venous thromboembolic events (VTE). The reported incidence of VTE in patients with ACTH-dependent or independent Cushing Syndrome (CS) is variable, ranging from 3 to 14%. Our aim was to assess the incidence of clinically significant VTE among patients with endogenous CS and to identify risk factors for the development of VTE. Methods: We conducted a single center retrospective longitudinal study of adult patients diagnosed with endogenous CS between 2010 and 2020. Patients with a known prothrombotic disease (e.g. Factor V Leiden), insufficient data, or non-neoplastic hypercortisolism were excluded. Data collected included patient demographics, presenting symptoms, biochemical and radiological workup, treatment details, and incidence of clinically significant VTE. Results: A total of 114 patients (mean age of 45.55 ± 14.78 years, 79.8% women) followed for mean of 3.26 ± 2.9 years were included. Of the 114 patients, 58 (50.9%) had Cushing disease (CD), 40 (35.1%) had CS due to adrenal adenoma/hyperplasia, 6 (3.5%) had adrenocortical carcinoma (ACC), and 10 (8.8%) had ectopic Cushing syndrome (eCS). The overall incidence of VTE at any time point was 14/114 (12.3%); 11 (79%) VTEs were associated with presence of an additional VTE risk factor (8 surgery and 3 malignancy). Prior to any intervention for CS, 3 of 114 (2.6%) patients had a VTE. Surgery for CS (adrenalectomy, transsphenoidal surgery, tumor resection) was performed in 97 patients (85.1%) whereas 17 were treated medically (n=10), died before treatment (n=1) or observed (n=6). VTE occurred in 2 patients receiving medical therapy for CS. The post-operative incidence of VTE was 9 (9.3%; 4 in CD, 1 in adrenal CS, 3 in ACC, and 1 in eCS). VTE occurred ≤ 3-month post-operative in 4 patients (44.4%). Among the 5 patients in whom VTE occurred >3 months post-operative, 3 had recurrent metastatic ACC with hypercortisolemia and 2 were in remission (1 with CS and 1 with eCS). The median time from surgery to VTE occurrence was 315 days (8-1006). Compared to those who did not develop VTE, those who developed VTE had higher mean 24-hour urine free cortisol (4663.6 vs 558.21 mcg/dL; n = 100, P < 0.0001) and mean 1 mg overnight dexamethasone suppression test (36.3 vs 11.8 mcg/dL; n = 69, P = 0.0003), but similar mean late-night salivary cortisol (0.591 vs 0.790 ng/dL, n = 84, P = 0.71) at diagnosis of CS. Discussion: Among those with CS, the overall incidence of VTE was 12.3% and the majority of VTE were provoked (surgery, malignancy). Moreover, VTE was more likely in those with higher UFC and 1 mg overnight dexamethasone suppression test in our cohort. This suggests that in patients with CS who have an active malignancy, severe CS or those undergoing a surgical procedure may be at increased risk of VTE. Future studies should investigate the optimal type and duration of the VTE prophylaxis.

scholarly journals COVID-19 and Cushing Disease: A Protective or a Deadly Combination?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A579-A579
Author(s):  
Ayesha Mehfooz ◽  
Takako Araki ◽  
Lynn Ann Burmeister
Keyword(s):  
Time Course ◽  
Cushing Syndrome ◽  
Disease Patient ◽  
Dexamethasone Suppression Test ◽  
Cushing Disease ◽  
Normal Limits ◽  
Free Cortisol ◽  
Suppression Test ◽  
Novel Coronavirus ◽  
Dexamethasone Suppression

Abstract Background: Manifestations of Cushing disease, including diabetes mellitus, hypertension, and obesity are risk factors for severe novel coronavirus disease 2019 (COVID-19) disease. A potential for severe COVID-19 disease might be hypothesized in Cushing disease patients. We present a finding of asymptomatic COVID-19 positive nasopharyngeal PCR test in an untreated Cushing disease patient. Case: A 19 year old female presented in January 2020 reporting amenorrhea and cushingoid facies. Her last menstrual period was two years ago. Low energy, fatigue, easy bruising and dark stretch marks on her legs, axillae and flanks were reported. Physical exam showed blood pressure 123/83 mmHg, pulse 89 bpm, BMI 20.80 kg/m². She had a cushingoid appearance with fullness in the face, neck and supraclavicular area, mild proptosis, pink cheeks and a few faint lavender striae on the inner thighs and flanks. Test results relevant to or supporting a diagnosis of Cushing disease included the following: 1 mg overnight dexamethasone suppression test: AM cortisol 23.9 ug/dl (6.7-22.6 ug/dl). Random 1019 hrs AM ACTH was 32 pg/ml (<47 pg/ml), cortisol 6.5 ug/dl (4-22ug/dl). Repeat 1 mg overnight dexamethasone suppression test: AM cortisol was 36.5 ug/dl (4-22 ug/dl), Dexamethasone 249.2 ng/dl (140-295 expected post 1 mg DXA the night before). 24 hr urine free cortisol was 391.4 (<=45.0 ug/d). Other endocrine labs were within normal limits. Left sided hypoenhancing lesion (2mmx2mmx2mm) consistent with pituitary microadenoma was seen on pituitary MRI. Inferior petrosal sinus sampling supported the presence of central disease and left pituitary location, concordant with the MRI. The time course from first clinical presentation to surgery was impacted by the COVID 19 pandemic temporarily halting elective surgical treatments and her access to care. At August, 2020 pre-op evaluation, the COVID-19 nasopharyngeal PCR was positive. Surgery was rescheduled. She denied symptoms of COVID-19 but recalled community exposure, including known COVID-19 positive contacts, while working as a waitress. Discussion: Increased susceptibility to and increased severity of COVID-19 manifestations might be feared in Cushing disease patients due to Cushing disease-associated immunosuppression, hyperglycemia, hypertension, obesity and venous thromboembolism. In contrast, randomized control trials have shown glucocorticoids, at doses sufficient to produce iatrogenic Cushing syndrome, may improve mortality in COVID-19 patients. Although asymptomatic COVID-19 infection is known to occur in young adults, the finding of asymptomatic COVID-19 positive test in a young woman with untreated Cushing disease also raises the possibility that endogenous hypercortisolism confers a similar benefit against severe manifestations of COVID-19 infection.

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