and Metabolic Syndrome: A Phenotype of Mild Long-Term Hypercortisolism?
Fig. 1 Overlap between Cushing’s syndrome and metabolic syndrome Although the example of Cushing’s syndrome makes a link between cortisol and obesity in the general population theoretically plausible, it represents…
Effects of Prior Cushing’s Syndrome
Fig. 1 Main clinical manifestations after remission of Cushing’s syndrome This chapter addresses current information on the main long-term/persistent effects of prior Cushing’s disease/glucocorticoid exposure. Cardiovascular and Metabolic Comorbidities Hypercortisolism…
Generalized Glucocorticoid Resistance or Chrousos Syndrome: Allostasis Through a Mutated Glucocorticoid Receptor
Target tissue Glucocorticoid hypersensitivity = Glucocorticoid excess Glucocorticoid resistance = Glucocorticoid deficiency Central nervous system Insomnia, anxiety, depression, defective cognition Fatigue, somnolence, malaise, defective cognition Liver + Gluconeogenesis, + lipogenesis…
Pathogenesis of Primary Adrenal Cushing’s Syndrome
Adrenocortical adenoma Micronodular disease Macronodular disease MAS PPNAD/iMAD/CNC BMAH A. Genetic alterations 1. cAMP/PKA signaling pathway – – MC2R a (missense) – GNAS a – GNAS a GNAS a…
and Nonneoplastic/Physiological Hypercortisolism: Cushing Versus Pseudo-Cushing Syndromes
Neoplastic/pathological hypercortisolism ACTH-secreting neoplasm Pituitary (Cushing disease) Non-pituitary (ectopic ACTH) Adrenal neoplastic disease Adrenocortical adenoma Adrenocortical carcinoma Bilateral adrenal nodular disease Primary pigmented micronodular hyperplasia Primary bilateral macronodular hyperplasia Nonneoplastic/physiological…
Metabolism as a Regulator of the Tissue-Specific Glucocorticoid Action
Fig. 1 Pre-receptor regulation of glucocorticoid availability governs access to bind and activate the glucocorticoid receptor Circulating GC levels are tightly controlled by the hypothalamo–pituitary–adrenal (HPA) axis , which regulates…
Disease, Refining the Definition of Remission and Recurrence
Author No. of patients (n) Follow-up (months) Remission rate (%) Overnight dexa Bochicchio et al. [41] 668 Mean 24; median 13 76.3 Chee et al. [56] 61 Median 88…
Adrenal Cortisol Excess
Fig. 1 Left adrenal incidentaloma with subtle autonomous cortisol secretion in a 37-year-old woman (white arrow); the right adrenal gland is partially atrophied (black arrow). Over 1 year, the cortisol…
Therapies in Cushing’s Syndrome
Steroidogenesis inhibitors Ketoconazole Metyrapone Mitotane Etomidate Centrally acting agents Cabergoline Pasireotide Glucocorticoid receptor antagonist Mifepristone Note: With the exception of pasireotide and mifepristone, these agents are used “off-label” in Cushing’s…
