Purpose Of Review: This article reviews the features of cyclical hypercortisolism. This syndrome was once considered to be very rare but is now being increasingly recognized.
Recent Findings: Either true cycles or the variant of episodic and fluctuating levels of hypercortisolism can lead to considerable clinical dilemmas, which are discussed. The review details possible pathophysiological mechanisms and the effects of centrally acting drugs.
Summary: 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. This type of case was initially thought to be rare. It has, however, recently been recognized as occurring much more frequently. 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. All of these can have very serious clinical consequences. Clinical researchers, including ourselves, have developed criteria, protocols and dynamic biochemical tools to detect cycling in patients with hypercortisolism. Unfortunately, the mechanisms causing the abnormal pathophysiology have not been well elucidated but some recent insights have been gained. The review discusses strategies for diagnosing and managing this important subgroup of patients with hypercortisolism.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/MED.0b013e3281a477b3 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Approach to the patient with Cyclical Cushing Syndrome.
J Clin Endocrinol Metab
December 2024
Department of Endocrinology, Diabetology, Metabolism and Nutrition, CHU Bordeaux, Bordeaux, France.
Cyclic Cushing's syndrome is a sub-entity of Cushing's syndrome, characterized by repeated episodes of excess cortisol (peaks) followed by spontaneous periods of normal or low cortisol secretion (troughs). Although considered rare, its prevalence reaches 70/514 to 91/514 (14 to 18%) in patients with Cushing's syndrome according to its definition in some reported series and can concern all etiologies of Cushing's syndrome. Physicians should be alert to the presence of cyclical Cushing's syndrome in patients with fluctuating symptoms or where the results of biochemical investigations indicate eu- or hypocortisolism in patients with clinical Cushing's syndrome.
View Article and Find Full Text PDFCircadian clock disruption impairs immune oscillation in chronic endogenous hypercortisolism: a multi-level analysis from a multicentre clinical trial.
EBioMedicine
December 2024
Department of Experimental Medicine, "Sapienza" University of Rome, Italy; Centre for Rare Diseases (Endo-ERN Accredited), Policlinico Umberto I, Rome, Italy. Electronic address:
Background: Glucocorticoids (GC) are potent entrainers of the circadian clock. However, their effects on biological rhythms in chronic human exposure have yet to be studied. Endogenous hypercortisolism (Cushing's Syndrome, CS) is a rare condition in which circadian disruption is sustained by a tumorous source of GC excess, offering the unique opportunity to investigate GC's chronic effects in vivo.
View Article and Find Full Text PDFA multi-year study of acoustic propagation and ambient sound in a Thalassia testudinum seagrass meadow in a shallow sub-tropical lagoona).
J Acoust Soc Am
November 2024
Applied Research Laboratories, The University of Texas at Austin, Austin, Texas 78766, USA.
Seagrasses provide a multitude of ecosystem services and act as important carbon sinks. However, seagrass habitats are declining globally, and they are among the most threatened ecosystems on earth. For these reasons, long-term and continuous measurements of seagrass parameters are of primary importance for ecosystem health assessment and sustainable management.
View Article and Find Full Text PDFDaytime plasma cortisol and cortisol response to dexamethasone suppression are associated with a prothrombotic state in hypertension.
Front Endocrinol (Lausanne)
June 2024
Internal Medicine and European Hypertension Excellence Center, Department of Medicine, University of Udine, Udine, Italy.
Background And Aims: A prothrombotic state was demonstrated in patients with Cushing's syndrome and is involved in the development and progression of cardiovascular and renal damage in hypertensive patients. This study was designed to examine the relationships between cortisol secretion and the hemostatic and fibrinolytic systems in hypertension.
Methods: In 149 middle-aged, nondiabetic, essential hypertensive patients free of cardiovascular and renal complications, we measured hemostatic markers that express the spontaneous activation of the coagulation and fibrinolytic systems and assessed daily cortisol levels (8 AM, 3 PM, 12 AM; area under the curve, AUC-cortisol) together with the cortisol response to dexamethasone overnight suppression (DST-cortisol).
Circadian and ultradian rhythms: Clinical implications.
J Intern Med
August 2024
Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, UK.
The hypothalamic-pituitary-adrenal axis is an extremely dynamic system with a combination of both circadian and ultradian oscillations. This state of 'continuous dynamic equilibration' provides a platform that is able to anticipate events, is sensitive in its response to stressors, remains robust during perturbations of both the internal and external environments and shows plasticity to adapt to a changed environment. In this review, we describe these oscillations of glucocorticoid (GC) hormones and why they are so important for GC-dependent gene activation in the brain and liver, and their consequent effects on the regulation of synaptic and memory function as well as appetite control and metabolic regulation.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!