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Endocrinology and metabolism
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Confirm raised cortisol with one or more of the following: Absent diurnal variation in cortisol: should not be detectable at midnight but is detectable in endogenous Cushing’s syndrome.Raised 24 hour urinary cortisol excretion.Failure to suppress cortisol during 48 hour low-dose dexamethasone suppression test.
Hormones of the Adrenal Gland
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
Suppression tests are used in suspected excess cortisol production. The dexamethasone suppression test is performed. Administration of dexamethasone, a synthetic glucocorticoid, produces a prompt feedback suppression of ACTH levels and cortisol secretion. If a tumour is oversecreting ACTH or cortisol, serum cortisol levels will not fall with the administration of dexamethasone.
Practice paper
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Cushing’s syndrome is not Cushing’s disease. The commonest cause of Cushing’s syndrome is steroid therapy. If the patient is not on steroid therapy, then other causes must be looked for with the use of biochemical tests and imaging. In the dexamethasone suppression test, serum cortisol measurements are taken after giving high doses of steroid. In a normal patient, there is negative feedback which causes decreased production of ACTH and therefore decreased serum cortisol. In Cushing’s syndrome and Cushing’s disease, there is failure to suppress cortisol production.
CyberKnife for the management of Cushing’s disease: our institutional experience and review of literature
Published in British Journal of Neurosurgery, 2021
Ashraf Abdali, Pavel L. Kalinin, Yuriy Y. Trunin, Ludmila E. Astaf’Eva, Alexey N. Shkarubo, Gennady E. Chmutin, Vishal Chavda, Andrey Golanov, Badshazar Abdali, Ilya V. Chernov, Atul Vats, Bipin Chaurasia
Medical records of all these 41 patients were looked for demographic data, baseline laboratory and radiography evaluations. Persistence of hypercortisolism following first trans-sphenoidal resections was confirmed based on high free urinary cortisol levels, high serum cortisol levels, and high ACTH levels. Dexamethasone suppression test was also performed for suspicious cases. Radiological findings were noted in accordance with the size of lesions (micro/macro adenomas), presence or absence of discrete lesion in post-operative MRI (visible/occult lesions), primary lesion (remnants of lesion allocated in surgically non accessible sites which resulted on a non-successful resection) or either regrowth of the lesion and involvement of the cavernous sinuses. The radiological assessment was done with contrast enhancement protocols in all cases. In two patients, prior radiation therapy was done in some other centre. Details about method of radiation treatment in these two cases were unavailable.
The role of serum osteoprotegerin level in diagnosis of disease and determining cardiovascular risk of polycystic ovary syndrome
Published in Gynecological Endocrinology, 2020
Zeynep Cetin, Dilek Berker, Berna Okudan, Muhammed Kilinckaya, Turan Turhan, Merve Catak
Eighty-five premenopausal women were included in the study. Fiftyseven of these women were newly diagnosed as PCOS and 28 were included as control group. None of them used drugs affecting metabolism and gynecological hormone parameters and had concomitant systemic disease. We excluded other causes of hyperandrogenism (congenital adrenal hyperplasia (CAH), Cushing’s syndrome, drugs, androgen-secreting tumors, etc.). The body mass indexes and the Ferriman-Gallwey score of patients with excessive hair growth were calculated, smoking, menstrual order, acne, seborrhea and androgenic alopecia were questioned. One mg oral dexamethasone suppression test was performed to rule out Cushing’s syndrome, and adrenocorticotropic hormone (ACTH)-stimulation test was performed in patients with high basal 17-hydroxy(OH) progesterone levels.
Non-adenomatous pituitary tumours mimicking functioning pituitary adenomas
Published in British Journal of Neurosurgery, 2020
Zize Feng, Zhigang Mao, Zongming Wang, Bing Liao, Yonghong Zhu, Haijun Wang
In the preoperative endocrinological assessment, the patient showed hypercortisolism of 27.6 µg/dL (reference value: 2.90–19.40 µg/dL) at 8 a.m. and an excessive 24-hour urinary cortisol level of 296.9 µg/dL (reference value: 4.3–176 µg/dl). Her plasma adrenocorticotropin hormone (ACTH) level was 11.9 pmol/L (reference value: 0–10.2 pmol/L). A low-dose dexamethasone suppression test showed serum cortisol and 24-hour urinary cortisol levels of 19.7 and 186.3 µg/dL, respectively, while a high-dose test revealed corresponding values of 3.4 and <0.8 µg/dL. A low-dose dexamethasone suppression test was unable to suppress the serum cortisol, while a >50% suppression of cortisol was found in the high-dose dexamethasone suppression test.