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Related Concept Videos

Cushing Syndrome I: Introduction01:26

Cushing 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...
Cushing Syndrome II: Pathophysiology01:19

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...
Adrenal Gland Disorders01:27

Adrenal 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...
Hyperthyroidism I: Introduction01:25

Hyperthyroidism I: Introduction

Hyperthyroidism is a type of thyrotoxicosis characterized by the thyroid gland's overproduction of the thyroid hormones triiodothyronine (T3) and thyroxine (T4). This hormone excess increases the basal metabolic rate and enhances sensitivity to catecholamines.DiagnosisDiagnosis is based on clinical features and biochemical testing. It typically shows suppressed thyroid-stimulating hormone (TSH) levels below 0.4 mIU/L, with elevated free T3 and/or T4. Additional tests, including thyroid...
Graves Disease II: Pathophysiology01:24

Graves 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...
Hyperthyroidism II: Pathophysiology01:27

Hyperthyroidism II: Pathophysiology

Hyperthyroidism is a hypermetabolic state caused by elevated levels of thyroid hormones, triiodothyronine (T3) and thyroxine (T4). It results from dysregulation at the thyroid, pituitary, or immune system level and affects multiple organ systems.PathophysiologyThe most common cause of hyperthyroidism is Graves’ disease, an autoimmune disorder in which antibodies, specifically thyroid-stimulating antibodies (TSAb), a subtype of TSH receptor antibodies (TRAb), bind to and activate TSH receptors...

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A Novel Method: Super-selective Adrenal Venous Sampling
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Published on: September 15, 2017

Subclinical Cushing's syndrome.

Monica De Leo1, Alessia Cozzolino, Annamaria Colao

  • 1Department of Molecular and Clinical Endocrinology and Oncology, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy.

Best Practice & Research. Clinical Endocrinology & Metabolism
|August 7, 2012
PubMed
Summary

Adrenal incidentalomas are common, with a subset developing subclinical Cushing's syndrome (SCS) causing subtle cortisol excess. Optimal diagnosis and management strategies for SCS remain unclear, necessitating further research.

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Area of Science:

  • Endocrinology
  • Oncology
  • Radiology

Background:

  • Abdominal imaging frequently reveals adrenal masses, termed adrenal incidentalomas.
  • Prevalence increases with age, ranging from 2-8% across different study types.
  • A significant percentage (5-20%) of these incidentalomas cause subclinical Cushing's syndrome (SCS), characterized by autonomous cortisol overproduction without overt symptoms.

Purpose of the Study:

  • To review the diagnostic challenges and management uncertainties surrounding subclinical Cushing's syndrome.
  • To highlight the association of SCS with metabolic and cardiovascular comorbidities.
  • To discuss current therapeutic options in the absence of definitive evidence-based guidelines.

Main Methods:

  • Literature review of studies on adrenal incidentalomas and subclinical Cushing's syndrome.
  • Analysis of diagnostic limitations for mild cortisol excess.
  • Examination of reported comorbidities and treatment approaches.

Main Results:

  • Standard tests for overt Cushing's syndrome are inadequate for SCS detection.
  • Patients with SCS exhibit increased prevalence of hypertension, obesity, diabetes, hyperlipidemia, and osteoporosis.
  • Long-term complication data is limited, leading to empirical management strategies.

Conclusions:

  • Subclinical Cushing's syndrome presents diagnostic and management challenges due to subtle hormonal excess and lack of clear long-term outcome data.
  • Current management is often empirical, considering adrenalectomy or treatment of associated conditions.
  • Further research is needed to establish evidence-based guidelines for SCS identification and treatment.