Endocrine problems in pregnancy
Philip E. Harris, Pierre-Marc G. Bouloux in Endocrinology in Clinical Practice, 2014
Diagnosis can be difficult in pregnancy, because normal reference ranges vary considerably. There are wide trimester-specific changes in urine free cortisol in pregnancy. An overnight dexamethasone suppression test is not reliable in pregnancy, and false-positive values may occur in pregnancy. The low-dose dexamethasone suppression test is the definitive diagnostic test for the syndrome. In the differential diagnosis of Cushing’s syndrome, one should consider that adrenal adenoma is responsible for 40%–50% in pregnancy compared with 15% outwith pregnancy. ACTH suppression, usually diagnostic of an adrenal cause outwith pregnancy, may be unsuppressed in half of pregnant mothers with a primary adrenal cause. The high-dose dexamethasone suppression test has increased utility in pregnancy. Magnetic resonance imaging (MRI) of the adrenal or pituitary will be performed depending on results.66 Inferior petrosal sinus sampling is safe and useful in pregnancy when indicated.
Adrenocortical function, adrenal insufficiency
Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner in Endocrine Surgery, 2017
Careful perioperative dosing of supplemental steroids is imperative when surgical resection of an adrenal nodule or nodules that are oversecreting cortisol is planned. All patients with adrenal nodules should have a 1 mg dexamethasone suppression test preoperatively, even if no signs or symptoms of Cushing’s are noted. Failure to suppress morning cortisol to <1.8 µg/dL after 1 mg of dexamethasone the night before with adequate serum dexamethasone levels for test interpretation should alert the surgeon that mild hypercortisolism may exist and should trigger some glucocorticoid replacement postoperatively. We recommend the use of high-dose cortisol during and immediately after unilateral adrenalectomy in patients with suspected hypercortisolism undergoing adrenalectomy. The surgery itself is a significant stress to the patient, and furthermore, the contralateral atrophic gland is dormant and is not capable of meeting the body’s requirements for cortisol. Additionally, the patient is likely to have transient primary AI for many months following unilateral adrenalectomy if hypercortisolism was noted prior to adrenalectomy, requiring steroid supplementation for upwards of a year of more. Recent literature suggests that even mild degrees of hypercortisolism preoperatively will result in the need for exogenous glucocorticoid therapy [17].
Clinical and Laboratory Evaluation of Adrenal Dysfunction
Fuad S. Ashkar, Lelio G. Colombetti in Radiobioassays, 2019
As suggested previously, hypercortisolism of ACTH-dependent or independent varieties would not arise if the pituitary-adrenal axis were appropriately responsive to increased steroid levels. This insight provided the basis for the dexamethasone suppression test proposed by Liddle8 to confirm the presence of abnormally regulated steroid production in suspected Cushing’s syndrome. The administration of 0.5 mg of dexamethasone orally every 6 hr for 2 days (“low dose dexamethasone suppression test”) dependably and reproducibly separates those with Cushing’s syndrome of any cause from patients (even those with marked obesity) with a normal pituitary-adrenal axis. Under these circumstances, urinary steroid levels fall below 4 mg/24 hr in normals, but exceed this value in those with Cushing’s syndrome (Figure 2). When properly carried out, this test is surely among the most reliable of diagnostic laboratory procedures in general clinical usage. During a decade and a half of application, no more than a handful of false negatives has been reported. It must be considered the standard criterion for establishing the diagnosis of hypercortisolism.
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.
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.
Severe ectopic Cushing’s syndrome
Published in Baylor University Medical Center Proceedings, 2020
Ankur Modi, Jamie Olejarski, Ashley Windham
Hypercortisolism must first be confirmed followed by a differentiation between an ACTH-dependent and -independent CS. In cases of CS with elevated ACTH levels, Cushing’s disease must be differentiated from EAS.2 Inferior petrosal sinus sampling is the most sensitive test for this purpose. It is the next step in evaluating ACTH-dependent CS when magnetic resonance imaging does not reveal a definite adenoma.3 A high-dose dexamethasone suppression test has limitations given that cortisol suppression is not present in 10% to 20% of patients with ACTH-secreting pituitary gland adenomas. Once EAS is diagnosed, visualization studies are required, usually with computed tomography of the neck, chest, abdomen, and pelvis; however, tumors are not identified in 19% of patients.4
Related Knowledge Centers
- Adrenal Gland
- Cortisol
- Dexamethasone
- Cushing'S Syndrome
- Pituitary Gland
- Adrenocorticotropic Hormone
- Glucocorticoid
- Blood–Brain Barrier
- Corticotropin-Releasing Hormone
- Acth Stimulation Test