Bio Categories

Chemical structure of cortisol.

Chemical structure of cortisol. (Photo credit: Wikipedia)

List of all the categories from Cushing’s Bios

Headache and pituitary disease A systematic review

Clinical Endocrinology, 08/15/2013  Evidence Based Medicine  Review Article

Kreitschmann–Andermahr I et al. –

English: Cavernous sinus

English: Cavernous sinus (Photo credit: Wikipedia)

Headache is very common in pituitary disease and is reported to be present in more than a third of all patients with pituitary adenomas.

Tumour size, cavernous sinus invasion, traction or displacement of intracranial pain–sensitive structures such as blood vessels, cranial nerves and dura mater, and hormonal hypersecretion are implicated causes.

Some studies suggest that oversecretion of GH and prolactin may be important for the development of headaches and treatment, particularly with somatostatin analogues, has been shown to improve symptoms in these patients.

Otherwise, treatment rests on general treatment options for headaches based an accurate clinical history and a precise classification which includes assessment of the patient’s psychosocial risk factors.

From PubMed

What is the Best Approach to Suspected Cyclical Cushing Syndrome?

Strategies for Managing Cushing’s Syndrome With Variable Laboratory Data

Brew Atkinson, Karen R. Mullan

Disclosures

Clin Endocrinol. 2011;75(1):27-30.

 

Abstract

Cyclical Cushing’s syndrome is a pattern of hypercortisolism in which the biochemistry of cortisol production fluctuates rhythmically. This syndrome is often associated with fluctuating symptoms and signs. It is now being increasingly recognized. The phenomenon is important because it can, if not recognized, lead to errors in diagnosis and differential diagnosis of the syndrome and in assessment of therapeutic outcomes. The techniques and criteria, protocols and dynamic biochemical tools to detect cycling in patients with hypercortisolism are discussed as are the strategies for diagnosing and managing this important subgroup of patients with hypercortisolism.

Introduction

Cyclical Cushing’s syndrome (CS) is a pattern in hypercortisolism in which the biochemistry of cortisol production fluctuates rhythmically. This can also be associated with fluctuating symptoms and signs. This type of case was initially thought to be rare. However, it has recently been recognized as occurring much more frequently. The phenomenon is important because, if not recognized, it can lead to errors in diagnosis and differential diagnosis of the syndrome and in assessment of therapeutic outcomes. All of these can have very serious clinical consequences.

As a result of reading this article, it is hoped that readers will be better able to consider more carefully the risks associated with too wide a diagnostic trawl for the diagnosis of CS and the associated chances of finding some abnormality of steroid biochemistry.

In cases where the diagnosis is being strongly considered, the risks of not considering episodic secretion when laboratory results are discordant are discussed. Readers should be able to plan strategies to assess for variable and cyclical secretion and to use these in diagnosis, differential diagnosis and treatment assessments.

Read more here: What is the best approach to suspected cyclical Cushing syndrome?

Approach to testing growth hormone (GH) secretion in obese subjects.

Source

Faculty of Medicine, University of Belgrade, Department of Neuroendocrinology, Clinical Center Serbia, Dr Subotic 13, 11000 Belgrade, Serbia. popver@eunet.rs

Abstract

Identification of adults with GH deficiency (GHD) is challenging because clinical features of adult GHD are not distinctive and because clinical suspicion must be confirmed by biochemical tests.

Adults are selected for testing for adult GHD if they have a high pretest probability of GHD, ie, if they have hypothalamic-pituitary disease, if they have received cranial irradiation or central nervous system tumor treatment, or if they survived traumatic brain injury or subarachnoid hemorrhage.

Testing should only be carried out if a decision has already been made that if deficiency is found it will be treated. There are many pharmacological GH stimulation tests for the diagnosis of GHD; however, none fulfill the requirements for an ideal test having high discriminatory power; being reproducible, safe, convenient, and economical; and not being dependent on confounding factors such as age, gender, nutritional status, and in particular obesity.

In obesity, GH secretion is reduced, GH clearance is enhanced, and stimulated GH secretion is reduced, causing a false-positive result. This functional hyposomatotropism in obesity is fully reversed by weight loss. In conclusion, GH stimulation tests should be avoided in obese subjects with very low pretest probability.

PMID:
23650336
[PubMed – in process]

J Clin Endocrinol Metab. 2013 May;98(5):1789-96. doi: 10.1210/jc.2013-1099.

From http://www.ncbi.nlm.nih.gov/pubmed/23650336

Quality of Life and Other Outcomes in Children Treated for Cushing Syndrome

Abstract

Journal of Clinical Endocrinology and Metabolism, 05/16/2013  Review Article  Clinical Article

Keil MF – Cushing syndrome (CS) in children is associated with residual impairment in measures of health–related quality of life, even after successful resolution of hypercortisolemia, highlighting the need for early identification of morbidities and improvements in long–term management of these patients.

A review of the literature identifies significant morbidities associated with CS of pediatric onset, which must not be treated in isolation. CS affects children and adolescents in many ways that are different than adults.

Post–treatment challenges for the child or adolescent treated for CS include: optimize growth and pubertal development, normalize body composition, and promote psychological health and cognitive maturation. All these factors impact health–related quality of life, which is an important outcome measure to assess the burden of disease as well as the effect of treatment.

Get this article here

%d bloggers like this: