ABSTRACT Objective: To evaluate the cumulative incidence, risk factors, and outcomes of COVID-19 in patients with Cushing’s disease (CD). Subjects and methods: In all, 60 patients with CD following up in our outpatient clinic answered via phone interview a questionnaire about the occurrence of COVID-19 infection documented by RT-PCR (including the diagnosis date and clinical outcome) and vaccination status. Clinical and biochemical data on disease activity (hypercortisolism) and comorbidities (obesity, diabetes mellitus, and hypertension) were obtained from the patients’ electronic […]

Cushing’s syndrome (CS) is a chronic and systemic disease caused by endogenous or exogenous hypercortisolism, associated with an increase of mortality rate due to the clinical consequences of glucocorticoid excess, especially cardiovascular diseases. After cure, usually obtained by the surgical removal of the tumor responsible for the disease, the normalization of cortisol secretion is not constantly followed by the recovery of the clinical complications developed during the active disease, and it is often followed by the development of novel clinical […]

Cushing’s syndrome (CS) results from sustained pathologic hypercortisolism. The clinical features are variable and the most specific features for CS include abnormal fat distribution, particularly in the supraclavicular and temporal fossae, proximal muscle weakness, wide purple striae, and decreased linear growth with continued weight gain in a child. Clinical presentation of CS can be florid and in this case the diagnosis is usually straightforward. However, the diagnosis can be difficult particularly in states of mild or cyclical or periodical hypercortisolism. […]

Pseudo-Cushing syndromes are a heterogeneous group of disorders, including alcoholism, anorexia nervosa, visceral obesity, and depression, which share many of the clinical and biochemical features of Cushing’s syndrome. The mechanisms responsible for the genesis of pseudo-Cushing’s syndrome are poorly understood. It has been suggested that hypercortisolism of pseudo-Cushing syndrome may be the result of increased hypothalamic corticotrophin-releasing hormone (CRH) secretion in the context of a hypothalamic-pituitary-adrenal axis that is otherwise normally constituted. The substantial overlap in clinical and biochemical features […]

Among endocrine disorders, Cushing’s syndrome (CS) is certainly one of the most challenging to endocrinologists due to the difficulties that often appear during investigation. The diagnosis of CS involves two steps: confirmation of hypercortisolism and determination of its etiology. Biochemical confirmation of the hypercortisolaemic state must be established before any attempt at differential diagnosis. Failure to do so will result in misdiagnosis, inappropriate treatment, and poor management. It should also be kept in mind that hypercortisolism may occur in some […]

Based on autopsy studies, adrenal masses are among the most common tumors in humans. Endogenous Cushing’s syndrome (CS) is unusual and adrenal adenomas account for 10% of all cases of CS. Patients with subclinical CS (SCS) present abnormal cortisol dynamics without obvious manifestations. The prevalence of hypercortisolism in clinically inapparent adrenal masses has been reported as 9%. Data from several small series of patients indicate that fewer than 20% develop hormone overproduction when followed for up to 10 years. Follow-up […]

Endogenous Cushing’s Syndrome (CS) is unusual. Patients with subclinical CS (SCS) present altered cortisol dynamics without obvious manifestations. CS occurs in 2-3% of obese poorly controlled diabetics. We studied 103 overweight adult outpatients with type 2 diabetes to examine for cortisol abnormalities and SCS. All collected salivary cortisol at 23:00 h and salivary and serum cortisol after a 1 mg dexamethasone suppression test (DST). Patients whose results were in the upper quintile for each test (253 ng/dL, 47 ng/dL, and […]

We studied clinical and laboratorial features of 73 patients with endogenous Cushing’s syndrome, subdivided as follows: 46 (63%) with Cushing’s disease (CD), 21 (28.7%) with an adrenal tumor and 6 (8.2%) with ectopic ACTH secretion (EAS). The rate of typical manifestations of hypercortisolism was similar regardless its etiology. In 100% of cases of Cushing’s syndrome we observed serum cortisol levels greater than 1.8 µg/dL in low-dose dexamethasone (DMS) suppression tests, as well as elevation of serum or salivary midnight cortisol. […]

Measurement of salivary cortisol, which evaluates the free form of the hormone, has become popular following the development of commercial assays. This article evaluates the different assays available for measurement of salivary cortisol, and its clinical application in some physiological and pathological conditions. Measurement of salivary cortisol has been extensively used to evaluate cortisol circadian rhythm and adrenal insufficiency, in the first days of life of full-term and pre-term infants, and to evaluate the hypothalamic-pituitary-adrenal axis (HPA) activity in adults […]

The diagnosis of Cushing’s syndrome require an accurate clinical suspicion, information about hypothalamic-pituitary-adrenal axis, adequate use of functional hormonal tests and the indication of resolutive image examination with the objective of determining its etiology. In this paper, we discuss the diagnostic approach of the Cushing’s syndrome, the application of the hormonal tests used for the syndromic and etiologic definition, with special focus in the differential diagnosis of Cushing’s Disease vs. pseudo-Cushing’s states and Cushing’s disease vs. ectopic ACTH syndrome. Finally, […]

Surgical approach is still the optimal therapy for endogenous Cushing’s syndrome. However, pharmacotherapy has a role as primary or adjunctive therapy, when surgery fails or the patient refuses or cannot be submitted to surgery. Steroidogenesis inhibitors are the main drugs used to control Cushing’s syndrome by reducing cortisol levels by adrenolytic or direct blocking enzymatic actions. Ketoconazol is effective as monotherapy; methyrapone and mitotane are also effective as single on combined therapy. Neuromodulators (compounds that modulate ACTH release from a […]

Chronic hypercortisolism is the most frequent cause of secondary osteoporosis involving mainly trabecular bone. Approximately 30-35% of the patients with Cushing’s syndrome present with compression fractures of vertebrae, and the risk of femoral neck fracture is increased in 50% in that population. Several mechanisms have been proposed to explain the association between hypercortisolism and osteoporosis, as the direct action of glucocorticoids in parathyroid glands and bone cells, alterations in the production of prostaglandins, citokines, interleukines, growth hormone (GH), insulin like […]