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García CJ, Sirera PS, Torregrosa Quesada ME, Bueno VG, Guerra RA. Relevance of inferior petrosal sinus sampling in the diagnosis of Cushing's syndrome: a case report. ADVANCES IN LABORATORY MEDICINE 2022; 3:407-414. [PMID: 37363427 PMCID: PMC10197457 DOI: 10.1515/almed-2022-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/30/2022] [Indexed: 06/28/2023]
Abstract
Objectives Non-specific signs and symptoms of Cushing's syndrome (CS) can pose a diagnostic challenge. Case presentation We report the case of a man referred to the service of endocrinology for suspected CS. Hypercortisolism was confirmed on CS screening tests, whereas diagnostic tests confirmed the presence of adrenocorticotropin (ACTH) -dependent CS. The corticotropin-releasing hormone stimulation (CRH) test was performed to determine whether CS had an endogenous or ectopic origin. Since the CRH and the magnetic resonance imaging (MRI) test were negative, IPSS was performed and suggested that CS was originated in the pituitary glands. Transsphenoidal pituitary resection was carried out. Histopathological analysis confirmed the cortitotrope origin of the tumor. Conclusions The etiological study and differential diagnosis of CS are complex processes that involve a variety of biochemical and imaging tests. It is important that a sequence of biochemical screening and diagnostic tests is performed, along with studies for establishing the location of the lesion, to determine whether CS has an adrenal, pituitary or ectopic origin. Despite its good diagnostic performance, the results of biochemical tests may not be conclusive, especially in ACTH-dependent CS. In the case reported, the inconclusive results obtained in the CRH test rendered an invasive procedure (IPSS) necessary, which ultimately confirmed diagnosis.
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Affiliation(s)
- Clara Jiménez García
- Clinical Laboratory, Hospital General Universitario de Alicante, Alicante, Spain
| | - Paula Sirera Sirera
- Clinical Laboratory, Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | - Rocío Alfayate Guerra
- Hormone Testing Laboratory, Hospital General Universitario de Alicante, Alicante, Spain
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Moreno Parro I, Ortiz Sánchez D, García Moreno R, Gómez Rioja R, Frutos Martínez R, Álvarez-Escolá C. Bilateral inferior petrosal sinus sampling in the diagnosis of ACTH-dependent Cushing's syndrome: experience in a tertiary hospital. ADVANCES IN LABORATORY MEDICINE 2022; 3:282-294. [PMID: 37362143 PMCID: PMC10197771 DOI: 10.1515/almed-2022-0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/01/2022] [Indexed: 06/28/2023]
Abstract
Objectives Bilateral inferior petrosal sinus sampling (BIPSS) is a useful test for differential diagnosis of central vs. ectopic adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome (CS). We provide a description of the protocol used in our Center and an analysis of its diagnostic accuracy. Methods A retrospective study was conducted of 28 patients who underwent BIPSS combined with corticotropin-releasing hormone (CRH) stimulation. The procedure is performed in an interventional neuroradiology suite, involving a multidisciplinary team of neuroradiologists, endocrinologists and laboratory professionals. The two petrosal sinuses are catheterized and a peripheral blood sample is obtained simultaneously, at baseline and at 3, 6 and 10 min following stimulation. ACTH and prolactin are determined by immunochemiluminescence. Results A total of 19 cases of Cushing's disease (CD) and 1 case of ectopic CS were confirmed. In all cases, BIPSS provided accurate diagnostic guidance, with a sensitivity and specificity of 100%. In 8 patients, remission was not achieved after surgery. In 84% of catheterizations, ACTH ratio peaked at 3-6 min following stimulation. Patients with histologically-confirmed CD exhibited higher sinus ACTH ratios and values. Prolactin ratio helped us identify and exclude 28.6% of the samples with inconsistent results. Conclusions In our series, BIPSS combined with CRH stimulation demonstrated to be a safe, effective procedure. Prolactin emerges as a useful marker of correct catheterization. The participation of a multidisciplinary team is essential.
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Affiliation(s)
- Isabel Moreno Parro
- Laboratory Medicine Department, La Paz University Hospital-Carlos III-Cantoblanco, Madrid, Spain
| | - David Ortiz Sánchez
- Laboratory Medicine Department, La Paz University Hospital-Carlos III-Cantoblanco, Madrid, Spain
| | - Rosa García Moreno
- Endocrinology Department, La Paz University Hospital-Carlos III-Cantoblanco, Madrid, Spain
| | - Rubén Gómez Rioja
- Laboratory Medicine Department, La Paz University Hospital-Carlos III-Cantoblanco, Madrid, Spain
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Alam BF, Nayab T, Ali S, AlSheikh R, Khan AM, Al Hinai MT, Farooq I. Current Scientific Research Trends on Salivary Biomarkers: A Bibliometric Analysis. Diagnostics (Basel) 2022; 12:diagnostics12051171. [PMID: 35626325 PMCID: PMC9140513 DOI: 10.3390/diagnostics12051171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/16/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022] Open
Abstract
Salivary biomarkers are indicators of many biological and pathological conditions and provide further information regarding the early detection of diseases. This bibliometric analysis aims to identify and evaluate the scientific literature addressing salivary biomarkers from a dental perspective, to identify the most prolific organizations, authors, journals, countries, and keywords used within this research domain. An electronic search was performed using Elsevier’s Scopus database. From a total of 587 retrieved papers (published between 1997 and 2021), 399 were selected. For the data analysis and its visualization, the title of the articles, year of publication, countries, authors, journals, articles, and keywords were analyzed using Microsoft Excel and VOSviewer (a bibliometric software program). An increase in the number of publications was identified from 1997 to 2021. The United States (U.S.) published the most papers (84) and received the highest citations (3778), followed by India and Brazil. The Journal of Periodontology published the highest number of articles (39) that received the highest citations. The University of Kentucky from the U.S. published most of the papers related to salivary biomarkers that received the highest citations. Timo Sorsa published the most papers (14 papers), while Craig Miller was the highest cited author (754 citations). Concerning the highly cited papers, a paper by Micheal et al., published in 2010, received the highest citations (487 citations). “Saliva”, followed by “human”, were the most common keywords used by the authors in the papers related to salivary biomarkers. The findings of this analysis revealed an increase in salivary biomarker-related publications that positively influenced the number of citations each paper received. The U.S. produced the most publications that received the highest citations, and the University of Kentucky, U.S., was the most prominent. The articles were mostly published in the Journal of Periodontology and received the highest number of citations.
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Affiliation(s)
- Beenish Fatima Alam
- Department of Oral Biology, Bahria University Dental College, Bahria University of Health Sciences, Karachi 75070, Pakistan;
| | - Talha Nayab
- Department of Dental Materials Science, Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University, Karachi 75070, Pakistan;
| | - Saqib Ali
- Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; (S.A.); (A.M.K.)
| | - Rasha AlSheikh
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia;
| | - Asim Mustafa Khan
- Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; (S.A.); (A.M.K.)
| | - Muntasar T. Al Hinai
- Dental and Maxillofacial Surgery Department, Sultan Qaboos University Hospital, P.O. Box 35 Muscat, Oman;
| | - Imran Farooq
- Faculty of Dentistry, University of Toronto, Toronto, ON M5G 1G6, Canada
- Correspondence:
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Melguizo-Rodríguez L, Costela-Ruiz VJ, Manzano-Moreno FJ, Ruiz C, Illescas-Montes R. Salivary Biomarkers and Their Application in the Diagnosis and Monitoring of the Most Common Oral Pathologies. Int J Mol Sci 2020; 21:ijms21145173. [PMID: 32708341 PMCID: PMC7403990 DOI: 10.3390/ijms21145173] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022] Open
Abstract
Saliva is a highly versatile biological fluid that is easy to gather in a non-invasive manner—and the results of its analysis complement clinical and histopathological findings in the diagnosis of multiple diseases. The objective of this review was to offer an update on the contribution of salivary biomarkers to the diagnosis and prognosis of diseases of the oral cavity, including oral lichen planus, periodontitis, Sjögren’s syndrome, oral leukoplakia, peri-implantitis, and medication-related osteonecrosis of the jaw. Salivary biomarkers such as interleukins, growth factors, enzymes, and other biomolecules have proven useful in the diagnosis and follow-up of these diseases, facilitating the early evaluation of malignization risk and the monitoring of disease progression and response to treatment. However, further studies are required to identify new biomarkers and verify their reported role in the diagnosis and/or prognosis of oral diseases.
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Affiliation(s)
- Lucía Melguizo-Rodríguez
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences (Ceuta), University of Granada, 51001 Granada, Spain;
- Instituto Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain; (V.J.C.-R.); (F.J.M.-M.); (R.I.-M.)
| | - Victor J. Costela-Ruiz
- Instituto Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain; (V.J.C.-R.); (F.J.M.-M.); (R.I.-M.)
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Francisco Javier Manzano-Moreno
- Instituto Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain; (V.J.C.-R.); (F.J.M.-M.); (R.I.-M.)
- Biomedical Group (BIO277), Department of Stomatology, School of Dentistry, University of Granada, 18071 Granada, Spain
| | - Concepción Ruiz
- Instituto Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain; (V.J.C.-R.); (F.J.M.-M.); (R.I.-M.)
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
- Institute of Neuroscience, University of Granada, 18016 Granada, Spain
- Correspondence: ; Tel.: +34-958243497
| | - Rebeca Illescas-Montes
- Instituto Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain; (V.J.C.-R.); (F.J.M.-M.); (R.I.-M.)
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
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Krylov V, Dobreva E, Kharnas S, Kuzntesov N, Nikolenko V, Marova E, Motalov V, Levkin V, Zharikov Y, Sinelnikov M. Adrenocorticotropic hormone-producing pheochromocytoma: A case report. Int J Surg Case Rep 2020; 68:59-62. [PMID: 32120279 PMCID: PMC7052437 DOI: 10.1016/j.ijscr.2020.01.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 02/08/2023] Open
Abstract
Our report features a clinical vignette of a rare case of adrenocorticotropic hormone (ACTH) producing pheochromocytoma in a patient with Cushing’s syndrome. The presented case of successful treatment of ACTH-producing pheochromocytoma was very difficult to correctly diagnose preoperatively due to the highly variable clinical manifestations of this disease, with typical signs of Cushing’s syndrome and pheochromocytoma sometimes unapparent. Comprehensive examination by clinical, biochemical, and radiological methods makes possible the detection of the source of ectopic ACTH secretion and allows for identification of such rare conditions.
Introduction Cases of ectopic production of adrenocorticotropic hormone are considerably rare, but persistent in clinical practice. Extremely rare cases of ectopic production, such as via pheochromocytoma secretion, require special clinical attention and prior knowledge. It is important to understand the diagnostic algorithm for identifying ectopic sources of adrenocorticotropic hormone production. Presentation of case In this clinical vignette we report a patient with a complex variety of clinical symptoms and no discernable cause for hypercriticism. Our clinical case outlines the diagnostic struggles, treatment challenges and surgical tactic for management of a rare ectopic ACTH producing pheochromocytoma. Discussion Highly variable clinical manifestations of ectopic ACTH producing pheochromocytoma, with typical signs of Cushing’s syndrome and pheochromocytoma account for significant diagnostic difficulties and low incidence of verification of this pathology. Correction of symptoms and patient stabilization are of utmost importance throughout treatment. Conclusion ACTH-dependent Cushing's syndrome, caused by a pheochromocytoma is extremely rare, but should be considered as a possible source for ACTH production. The diagnostic challenges of this condition can be met with confidence when a strict search protocol is conducted for detection of ACTH source.
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Affiliation(s)
- Vadim Krylov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Bolshaya Pirogovskaya St., 6/1, Moscow, 119146, Russian Federation
| | - Ekaterina Dobreva
- Endocrinology Research Centre, Dmitriya Ulyanova Street, Moscow, 117036, Russian Federation
| | - Sergey Kharnas
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Bolshaya Pirogovskaya St., 6/1, Moscow, 119146, Russian Federation
| | - Nikolay Kuzntesov
- Endocrinology Research Centre, Dmitriya Ulyanova Street, Moscow, 117036, Russian Federation
| | - Vladimir Nikolenko
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Bolshaya Pirogovskaya St., 6/1, Moscow, 119146, Russian Federation
| | - Evegenia Marova
- Endocrinology Research Centre, Dmitriya Ulyanova Street, Moscow, 117036, Russian Federation
| | - Vladimir Motalov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Bolshaya Pirogovskaya St., 6/1, Moscow, 119146, Russian Federation
| | - Vladimir Levkin
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Bolshaya Pirogovskaya St., 6/1, Moscow, 119146, Russian Federation
| | - Yury Zharikov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Bolshaya Pirogovskaya St., 6/1, Moscow, 119146, Russian Federation
| | - Mikhail Sinelnikov
- Institute for Regenerative Medicine, Sechenov University, Trubetskaya, 8, 119431, Russian Federation.
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Araujo-Castro M, Sampedro Núñez MA, Marazuela M. Autonomous cortisol secretion in adrenal incidentalomas. Endocrine 2019; 64:1-13. [PMID: 30847651 DOI: 10.1007/s12020-019-01888-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/28/2019] [Indexed: 02/06/2023]
Abstract
Adrenal incidentalomas (AI) are one of the most frequent reasons for consultation in Endocrinology, as they are present in 3-10% of the general population. Up to 20% of them may have autonomous cortisol secretion (ACS), a term that refers to AI carriers with biochemical evidence of excess cortisol, but without the "specific" clinical signs of Cushing's syndrome. As ACS is associated with an increased risk of diabetes, obesity, high blood pressure (HBP), osteoporosis, cardiovascular events, and global mortality; its correct identification is of great importance. There are different laboratory assays to detect ACS, but all of them have some limitations. The dexamethasone suppression test is the most accepted for screening. However, there is no consensus on the cutoff point that should be used. Low levels of ACTH and DHEA-S and high urinary free cortisol are also associated with ACS, but in isolation they are of little value to establish the diagnosis. Considering its clinical implications and the lack of consensus in the diagnosis and in which is the most appropriate management of these patients, this review offers a quick reference guide of ACS, presenting an exhaustive review of the topic: its definition, epidemiology, diagnosis, clinical implications, treatment, and follow-up.
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Affiliation(s)
- Marta Araujo-Castro
- Department of Endocrinology, Hospital Universitario La Princesa, Instituto de Investigación Princesa, Madrid, Spain.
| | - Miguel Antonio Sampedro Núñez
- Department of Endocrinology, Hospital Universitario La Princesa, Instituto de Investigación Princesa, Madrid, Spain.
| | - Mónica Marazuela
- Department of Endocrinology, Hospital Universitario La Princesa, Instituto de Investigación Princesa, Madrid, Spain.
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Olmos Jiménez M, Pelaz Berdullas L, Huidobro Fernández B, Royo Gómez M, Roldán Martín M. Enfermedad de Cushing en la infancia con presentación atípica. An Pediatr (Barc) 2012; 76:306-9. [DOI: 10.1016/j.anpedi.2011.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 10/27/2011] [Accepted: 11/29/2011] [Indexed: 11/16/2022] Open
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Herranz Antolín S, Bernal Bello D, Alvarez De Frutos V, Megino Moreno T. [ACTH-independent Cushing's syndrome secondary to macronodular adrenal hyperplasia]. ACTA ACUST UNITED AC 2010; 57:173-5. [PMID: 20395183 DOI: 10.1016/j.endonu.2010.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 02/25/2010] [Accepted: 02/25/2010] [Indexed: 11/16/2022]
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