Cyclic Cushing's syndrome: an overview
Nora Maria Elvira Albiger1, Carla M Scaroni, Franco Mantero
1Endocrinology Division, Department of Medical and Surgical Sciences, University of Padua, Italy.
Arquivos Brasileiros De Endocrinologia E Metabologia
|January 23, 2008
Summary
Cyclic Cushing's syndrome (CS) involves fluctuating glucocorticoid levels, often delaying diagnosis and complicating treatment. Accurate follow-up is crucial due to unpredictable hormonal shifts.
Area of Science:
- Endocrinology
- Internal Medicine
Background:
- Cyclic Cushing's syndrome (CS) is characterized by alternating normal and elevated glucocorticoid levels.
- This condition is more prevalent in children than adults and can manifest as ACTH-dependent or independent CS.
Purpose of the Study:
- To elucidate the complexities of cyclic Cushing's syndrome, including its pathophysiology, diagnostic challenges, and treatment implications.
Main Methods:
- Review of proposed pathophysiological mechanisms including serotoninergic influence, dopaminergic tone changes, tumor hemorrhage, and cytokines.
- Analysis of diagnostic difficulties, including delayed diagnosis and interpretation of dynamic tests like the dexamethasone suppression test.
- Examination of treatment challenges related to unpredictable hypocortisolism during normal cortisol phases.
Main Results:
- The cyclic nature of hypercortisolism complicates diagnosis, leading to delayed identification and interpretation issues with standard tests.
- Paradoxical responses to dexamethasone may occur, reflecting dynamic changes in endogenous activity.
- Treatment can be complicated by unexpected hypocortisolism when cortisol levels normalize cyclically.
Conclusions:
- The exact mechanism of cyclic CS requires further clarification.
- Accurate and periodic hormone assessments are essential for diagnosing suspected cyclic CS.
- Close patient follow-up is mandatory to manage treatment effectively and prevent complications arising from hormonal fluctuations.
Related Concept Videos
01:26Cushing Syndrome I: Introduction
Cushing syndrome refers to the collection of clinical manifestations that arise when tissues are exposed to excessive amounts of cortisol or cortisol-like medications over an extended period. Cortisol, a glucocorticoid produced by the adrenal cortex, regulates metabolism, immune responses, and the body’s adaptation to stress. When its concentration remains chronically elevated, these physiological pathways become dysregulated, resulting in the characteristic features of the syndrome.Exogenous...
01:19Cushing Syndrome II: Pathophysiology
Cortisol production is normally governed by the hypothalamic–pituitary–adrenal (HPA) axis, which maintains hormonal balance through tightly regulated feedback mechanisms. Disruption of this regulatory system is central to the development of Cushing syndrome, whether the excess cortisol originates from external medications or internal pathology. Persistent cortisol elevation alters metabolism, immune function, and endocrine signaling, producing the characteristic clinical features of the...
01:27Adrenal Gland Disorders
Adrenal gland disorders manifest when the production of adrenal hormones deviates from the norm, resulting in either excessive or insufficient concentrations.
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
01:23Cirrhosis I: Introduction
Cirrhosis is a chronic, irreversible liver disease characterized by the widespread replacement of healthy liver tissue with fibrotic scar tissue and the formation of regenerative nodules.Etiology of cirrhosisCirrhosis results from sustained liver injury that triggers progressive fibrosis and structural remodeling. The underlying causes are diverse, encompassing common and less frequent clinical conditions. Regardless of the origin, all causes lead to chronic inflammation, hepatocyte loss, and...
01:24Graves Disease II: Pathophysiology
Graves’ disease is an autoimmune disorder characterized by the production of thyroid-stimulating immunoglobulins (TSI) that activate TSH receptors, leading to excessive synthesis and release of thyroid hormones (T3 and T4) and resulting in hyperthyroidism.Among all causes of hyperthyroidism, Graves’ disease is the most common and can happen at any age, though it is more frequent in women. It produces a hypermetabolic state with features such as weight loss, tachycardia, tremor, and heat...
01:37Hypothalamic-Pituitary Axis
The response to stress—be it physical or psychological, acute or chronic—involves activation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. The HPA axis is part of the neuroendocrine system because it involves both neuronal and hormonal communication. Its function is to regulate homeostatic systems—metabolic, cardiovascular, and immune—providing the necessary means to respond to a stressor.