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Cushing 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...
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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...
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The most common cardiovascular diagnostic test is an X-ray. It produces images of the heart, blood vessels, and adjacent structures.
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Cardiac computed tomography (CT) scanning is an advanced cardiac imaging technique that utilizes CT technology, with or without intravenous (IV) contrast, to produce accurate cross-sectional virtual slices of specific areas of the heart, coronary circulation, and major blood vessels such as the aorta, pulmonary veins, and arteries. The computer processes these slices to generate three-dimensional images. Multidetector CT (MDCT) is a rapid form of CT scanning that captures multiple slices...
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A Novel Method: Super-selective Adrenal Venous Sampling
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Published on: September 15, 2017

Imaging in Cushing's syndrome.

Anju Sahdev1, Rodney H Reznek, Jane Evanson

  • 1Department of Diagnostic Imaging, St. Bartholomew's Hospital, London, UK anju.sahdev@bartsandthelondon.nhs.uk

Arquivos Brasileiros De Endocrinologia E Metabologia
|January 23, 2008
PubMed
Summary

Differentiating ACTH-dependent and independent Cushing's syndrome (CS) is crucial. Imaging, including CT and MRI, effectively identifies the cause, whether pituitary adenomas or ectopic ACTH sources, guiding treatment.

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Area of Science:

  • Endocrinology
  • Radiology
  • Oncology

Background:

  • Cushing's syndrome (CS) diagnosis requires differentiating ACTH-dependent (80%) from adrenal (20%) causes.
  • ACTH-dependent CS originates from pituitary microadenomas (Cushing's disease) or ectopic ACTH sources like lung carcinoma.
  • Accurate diagnosis relies on identifying the underlying pathology and its source.

Purpose of the Study:

  • To review adrenal imaging findings in ACTH-dependent and independent CS.
  • To discuss the role of MRI and CT in detecting and managing pituitary ACTH-secreting adenomas.
  • To highlight imaging's importance in identifying ectopic ACTH sources and adrenal pathology.

Main Methods:

  • Review of adrenal appearances in ACTH-dependent and independent CS.
  • Discussion on MRI and CT utilization for pituitary adenoma detection and management.
  • Emphasis on CT (chest, abdomen, pelvis with contrast) for ectopic ACTH source and adrenal pathology identification.
  • MRI application for adrenal adenoma characterization and complex case problem-solving.

Main Results:

  • Modern non-invasive imaging accurately identifies the cause and nature of CS pathology.
  • CT is highly sensitive for detecting ectopic ACTH sources and adrenal pathology.
  • MRI aids in characterizing adrenal adenomas and detecting pituitary ACTH-secreting adenomas.

Conclusions:

  • Imaging is essential for differentiating CS subtypes and locating pathologies.
  • CT and MRI are vital tools for diagnosing and managing Cushing's syndrome.
  • Effective imaging strategies ensure accurate diagnosis and guide appropriate treatment.