A Rational Approach to the Patient Suspected of Having Cushing’s Syndrome
In 1889 Sir William Osler detailed the case of a 31-year old man suffering from “an acute myxedematous condition, with tachycardia, glycosuria, melena, mania and death.” In particular, Osler was impressed by the rapid weight gain and the “bloated” appearance of his patient’s face. Unfortunately, however, the constellation of symptoms and signs that we now attribute to glucocorticoid excess had not been described and the patient succumbed while being treated for hypothyroidism. In 1932, Harvey Cushing described the clinical features associated with basophilic tumors of the pituitary. Since then, the association has become well characterized and patients with features due to glucocorticoid excess are said to have Cushing’s syndrome.
KeywordsHPLC Adenoma Cortisol Dexamethasone Expense
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- 3.Cushing HW. The Pituitary Body and Its Disorders: Clinical States Produced by Disorders of the Hypophysis Cerebri. Philadelphia: JB Lippincott, 1912.Google Scholar
- 5.Ross EJ and Linch DC. “Cushing’s Syndrome-Killing Disease: Discriminatory Value of Signs and Symptoms Aiding Early Diagnosis.” Lancet 646–649, 1982.Google Scholar
- 8.Hellman L, Weitzman ED, Roffwarg H, Fukushima D, Yoshida K, Gallagher T. Cortisol is Secreted Episodically in Cushing’s Syndrome. J Clin Endocrinol Metab 30: 686–689.Google Scholar
- 9.Flack MR, Oldfield EH, Cutler GB Jr., Flack MR, Oldfield EH, Cutler GB, Zweig MH, Malley JD, Chrousos GP, Loriaux DL, Nieman LK. Urine free cortisol in the high-dose dexamethasone suppression test for the differential diagnosis of the Cushing’s Syndrome. Ann Intern. Med 116:211–217, 1992.PubMedGoogle Scholar
- 10.Avergnious PC, Yanovski JA, Oldfield EH, Neiman LK, Cutler GB Jr. Metyrapone and dexamethasone suppression tests for the differential diagnosis of the adrenalcortocotropin-dependent Cushing’s Syndrome: A Comparison. Ann Intern Med 121: 318–327, 1994.Google Scholar
- 11.Dichek HL, Nieman LK, Oldfield EH, Pass HI, Malley JD, Cutler GB Jr. A Comparison of the standard high-dose dexamethasone suppression test and the overnight 8-mg dexamethasone suppression test for the differential diagnosis of adrenocortocotropin-dependent Cushing’s Syndrome. J Clin Endocrinol Metab. 78: 418–422, 1994.PubMedCrossRefGoogle Scholar
- 16.de Herder WW, Krenning EB, Malchoff CD, Hofland LJ, Riubi JC, Kwekkeboom DJ, Oei HY, Pols HA, Burnning HA, Nobels FR, Lamberts W. Somatostatin receptor scintigraphy: It’s value and tumor localization in patients with Cushing’s Syndrome caused by ectopic cortocotropin or cortocotropin-releasing hormone secretion. Am J. Med 96:305–312, 1994.PubMedCrossRefGoogle Scholar
- 19.Quddusi S, Browne P, Hirsch IB. Cushing’s Syndrome due to surreptitious glucocorticiod administration. JAMA 158: 294–296, 1998.Google Scholar