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Cyclic Cushing's syndrome: an overview
Franco Mantero1, Carla M Scaroni, Nora M E Albiger
1Division of Endocrinology, Department of Medical and Surgical Sciences, University of Padua, Italy. franco.mantero@unipd.it
Pituitary
|September 1, 2005
Summary
Cyclic Cushing's syndrome involves fluctuating ACTH secretion, often from pituitary adenomas. Diagnosis requires careful monitoring due to variable hormone levels.
Area of Science:
- Endocrinology
- Oncology
- Internal Medicine
Background:
- Cyclic Cushing's syndrome (CS) presents with rhythmic fluctuations in adrenocorticotropic hormone (ACTH) secretion.
- This hormonal imbalance leads to cyclical variations in adrenal steroid production, complicating diagnosis.
- Causes include ACTH-secreting pituitary adenomas, ectopic ACTH production, or adrenal adenomas.
Observation:
- Suspect cyclic CS in patients with hypercortisolism signs but normal cortisol levels.
- Paradoxical responses to dexamethasone tests may indicate fluctuating endogenous hormone activity.
- Diagnosis often necessitates lengthy observation periods and dynamic tests during sustained hypercortisolism.
Findings:
- Cyclic CS is primarily caused by pituitary adenomas secreting ACTH.
- Ectopic ACTH production and adrenal adenomas are less common etiologies.
- Variable steroidogenesis requires cautious interpretation of treatment responses.
Implications:
- Early suspicion and prolonged monitoring are crucial for diagnosing cyclic CS.
- Understanding hormonal fluctuations aids in appropriate diagnostic test interpretation.
- Careful management is needed due to the dynamic nature of steroidogenesis in cyclic CS.