1
|
Guarnotta V, Emanuele F, Salzillo R, Giordano C. Adrenal Cushing's syndrome in children. Front Endocrinol (Lausanne) 2023; 14:1329082. [PMID: 38192416 PMCID: PMC10773667 DOI: 10.3389/fendo.2023.1329082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/29/2023] [Indexed: 01/10/2024] Open
Abstract
Adrenal Cushing's syndrome is a rare cause of endogenous hypercortisolism in neonatal and early childhood stages. The most common causes of adrenal CS are hyperfunctioning adrenal tumours, adenoma or carcinoma. Rarer causes are primary bilateral macronodular adrenal hyperplasia (PBAMH), primary pigmented adrenocortical disease (PPNAD) and McCune Albright syndrome. The diagnosis represents a challenge for clinicians. In cases of clinical suspicion, confirmatory tests of hypercortisolism should be performed, similarly to those performed in adults. Radiological imaging should be always combined with biochemical confirmatory tests, for the differential diagnosis of adrenal CS causes. Treatment strategies for adrenal CS include surgery and in specific cases medical drugs. An adequate treatment is associated to an improvement of growth, bone health, reproduction and body composition from childhood into and during adult life. After cure, lifelong glucocorticoid replacement therapy and endocrine follow-up are required, notably in patients with Carney's complex disease.
Collapse
Affiliation(s)
- Valentina Guarnotta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Section of Endocrinology, University of Palermo, Palermo, Italy
| | | | | | | |
Collapse
|
2
|
Violon F, Bouys L, Berthon A, Ragazzon B, Barat M, Perlemoine K, Guignat L, Terris B, Bertherat J, Sibony M. Impact of Morphology in the Genotype and Phenotype Correlation of Bilateral Macronodular Adrenocortical Disease (BMAD): A Series of Clinicopathologically Well-Characterized 35 Cases. Endocr Pathol 2023. [PMID: 36864263 DOI: 10.1007/s12022-023-09751-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Bilateral macronodular adrenocortical disease (BMAD) is characterized by the development of adrenal macronodules resulting in a pituitary-ACTH independent Cushing's syndrome. Although there are important similarities observed between the rare microscopic descriptions of this disease, the small series published are not representative of the molecular and genetic heterogenicity recently described in BMAD. We analyzed the pathological features in a series of BMAD and determined if there is correlation between these criteria and the characteristics of the patients. Two pathologists reviewed the slides of 35 patients who underwent surgery for suspicion of BMAD in our center between 1998 and 2021. An unsupervised multiple factor analysis based on microscopic characteristics divided the cases into 4 subtypes according to the architecture of the macronodules (containing or not round fibrous septa) and the proportion of the different cell types: clear, eosinophilic compact, and oncocytic cells. The correlation study with genetic revealed subtype 1 and subtype 2 are associated with the presence of ARMC5 and KDM1A pathogenic variants, respectively. By immunohistochemistry, all cell types expressed CYP11B1 and HSD3B1. HSD3B2 staining was predominantly expressed by clear cells whereas CYP17A1 staining was predominant on compact eosinophilic cells. This partial expression of steroidogenic enzymes may explain the low efficiency of cortisol production in BMAD. In subtype 1, trabeculae of eosinophilic cylindrical cells expressed DAB2 but not CYP11B2. In subtype 2, KDM1A expression was weaker in nodule cells than in normal adrenal cells; alpha inhibin expression was strong in compact cells. This first microscopic description of a series of 35 BMAD reveals the existence of 4 histopathological subtypes, 2 of which are strongly correlated with the presence of known germline genetic alterations. This classification emphasizes that BMAD has heterogeneous pathological characteristics that correlate with some genetic alterations identified in patients.
Collapse
Affiliation(s)
- Florian Violon
- Université Paris-Cité, Institut Cochin, CNRS UMR8104, Inserm U1016, Paris, France
- Department of Pathology, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Lucas Bouys
- Université Paris-Cité, Institut Cochin, CNRS UMR8104, Inserm U1016, Paris, France
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Annabel Berthon
- Université Paris-Cité, Institut Cochin, CNRS UMR8104, Inserm U1016, Paris, France
| | - Bruno Ragazzon
- Université Paris-Cité, Institut Cochin, CNRS UMR8104, Inserm U1016, Paris, France
| | - Maxime Barat
- Université Paris-Cité, Institut Cochin, CNRS UMR8104, Inserm U1016, Paris, France
| | - Karine Perlemoine
- Université Paris-Cité, Institut Cochin, CNRS UMR8104, Inserm U1016, Paris, France
| | - Laurence Guignat
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Benoit Terris
- Department of Pathology, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jérôme Bertherat
- Université Paris-Cité, Institut Cochin, CNRS UMR8104, Inserm U1016, Paris, France.
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France.
| | - Mathilde Sibony
- Université Paris-Cité, Institut Cochin, CNRS UMR8104, Inserm U1016, Paris, France.
- Department of Pathology, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France.
| |
Collapse
|
3
|
Espiñeira IM, Vidal PN, Ghersevich MC, Soler Arias EA, Bosetti F, Cabrera Blatter MF, Miceli DD, Castillo VA. Adrenal cortex stimulation with hCG in spayed female dogs with Cushing's syndrome: Is the LH-dependent variant possible? Open Vet J 2021; 11:319-329. [PMID: 34307090 PMCID: PMC8288738 DOI: 10.5455/ovj.2021.v11.i2.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/23/2021] [Indexed: 11/09/2022] Open
Abstract
Background: The expression and overexpression of luteinizing hormone (LH) receptors in the canine adrenal gland cortex have been reported. Therefore, it was hypothesized that a LH-dependent form of Cushing’s syndrome (CS) could exist in dogs. Aim: To assess whether the adrenal gland post-ovariectomy (OVx) exhibits a greater response to adrenocorticotrophin (ACTH) stimulation; to evaluate whether the adrenal gland responds to human chorionic gonadotropin (hCG) stimulation by increasing the release of cortisol; and to consider whether hCG stimulus testing would be useful as a diagnosis for possible cases of LH-dependent CS. Methods: Cortisol concentrations were measured from healthy female dogs (n=16) at baseline and following ACTH stimulation before and 2 months after gonadectomy (OVx). Cortisol concentrations were also measured for female dogs with CS (n = 14) following administration of hCG (5000 IU). A post-hCG cortisol concentration greater than 140 nmol/l was used to define dogs with LH-dependent Cushing’s syndrome. Results: In normal female dogs, both pre- and post-stimulation cortisol concentrations increased following OVx (p = 0.002 and p = 0.0003, respectively). In female dogs with CS, cortisol concentrations increased following stimulation with hCG in 57% (8/14; p = 0.002). Age at the time of OVx was associated (p = 0.015) with the cortisol response to hCG [8 (5–9) years vs. 3.5 (2–6) years, p = 0.0013). Conclusion: Based on these results, an LH-dependent form of CS occurs in spayed female dogs, and that it is more likely to occur when female dogs are spayed later in life.
Collapse
Affiliation(s)
- Ignacio M Espiñeira
- Facultad de Ciencias Veterinarias, Cátedra de Clínica Médica de Pequeños Animales, Universidad de Buenos Aires, Buenos Aires, Argentina.,Becario Estímulo UBACyT, Rep. Argentina
| | - Patricia N Vidal
- Hospital Escuela de Medicina Veterinaria-U. Endocrinología, Rep. Argentina.,Becaria Proyecto Estratégicos UBACyT, Rep. Argentina
| | - María C Ghersevich
- Facultad de Ciencias Agropecuarias, U. Católica de Córdoba-Argentina, Rep. Argentina
| | | | - Fernanda Bosetti
- Facultad de Ciencias Veterinarias, Cátedra de Clínica Médica de Pequeños Animales, Universidad de Buenos Aires, Buenos Aires, Argentina.,Hospital Escuela de Medicina Veterinaria-U. Endocrinología, Rep. Argentina
| | - María F Cabrera Blatter
- Facultad de Ciencias Veterinarias, Cátedra de Clínica Médica de Pequeños Animales, Universidad de Buenos Aires, Buenos Aires, Argentina.,Hospital Escuela de Medicina Veterinaria-U. Endocrinología, Rep. Argentina
| | - Diego D Miceli
- Hospital Escuela de Medicina Veterinaria-U. Endocrinología, Rep. Argentina.,IByME-CONICET, Rep. Argentina
| | - Víctor A Castillo
- Facultad de Ciencias Veterinarias, Cátedra de Clínica Médica de Pequeños Animales, Universidad de Buenos Aires, Buenos Aires, Argentina.,Hospital Escuela de Medicina Veterinaria-U. Endocrinología, Rep. Argentina
| |
Collapse
|
4
|
Regazzo D, Barbot M, Scaroni C, Albiger N, Occhi G. The pathogenic role of the GIP/GIPR axis in human endocrine tumors: emerging clinical mechanisms beyond diabetes. Rev Endocr Metab Disord 2020; 21:165-183. [PMID: 31933128 DOI: 10.1007/s11154-019-09536-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The glucose-dependent insulinotropic polypeptide (GIP) is an incretin hormone produced in the gastrointestinal tract in response to nutrients. GIP has a variety of effects on different systems, including the potentiation of insulin secretion from pancreatic β-cells after food intake (i.e. incretin effect), which is probably the most important. GIP effects are mediated by the GIP receptor (GIPR), a G protein-coupled receptor expressed in several tissues, including islet β-cells, adipocytes, bone cells, and brain. As well as its involvement in metabolic disorders (e.g. it contributes to the impaired postprandial insulin secretion in type 2 diabetes (T2DM), and to the pathogenesis of obesity and associated insulin resistance), an inappropriate GIP/GIPR axis activation of potential diagnostic and prognostic value has been reported in several endocrine tumors in recent years. The ectopic GIPR expression seen in patients with overt Cushing syndrome and primary bilateral macronodular adrenal hyperplasia or unilateral cortisol-producing adenoma has been associated with an inverse rhythm of cortisol secretion, with low fasting morning plasma levels that increase after eating. On the other hand, most acromegalic patients with an unusual GH response to oral glucose suppression have GIPR-positive somatotropinomas, and a milder phenotype, and are more responsive to medical treatment. Neuroendocrine tumors are characterized by a strong GIPR expression that may correlate positively or inversely with the proliferative index MIB-1, and that seems an attractive target for developing novel radioligands. The main purpose of this review is to summarize the role of the GIP/GIPR axis in endocrine neoplasia, in the experimental and the clinical settings.
Collapse
Affiliation(s)
- Daniela Regazzo
- Department of Medicine Endocrinology Unit, Padova University Hospital, Padova, Italy
| | - Mattia Barbot
- Department of Medicine Endocrinology Unit, Padova University Hospital, Padova, Italy
| | - Carla Scaroni
- Department of Medicine Endocrinology Unit, Padova University Hospital, Padova, Italy
| | - Nora Albiger
- Endocrinology Service, ULSS 6 Euganea, Padova, Italy
| | - Gianluca Occhi
- Department of Biology, University of Padova, Padova, Italy.
| |
Collapse
|
5
|
Carotenuto G, Malerba E, Dolfini C, Brugnoli F, Giannuzzi P, Semprini G, Tosolini P, Fracassi F. Cushing's syndrome-an epidemiological study based on a canine population of 21,281 dogs. Open Vet J 2019; 9:27-32. [PMID: 31086762 PMCID: PMC6500859 DOI: 10.4314/ovj.v9i1.5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/23/2019] [Indexed: 11/24/2022] Open
Abstract
The epidemiological characteristics of spontaneous hypercortisolism (HC) were derived from 21,281 client-owned dogs selected from four private veterinary clinics and one university reference center for endocrinology. The odds ratio (OR) method was employed to investigate the risk of developing HC related to breed, gender, and sexual status. The estimated prevalence of HC in the four private clinics was 0.20% [95% confidence interval (CI), 0.13–0.27] and was significantly different compared to the university reference center (1.46%; 95% CI, 1.12–1.80). Sex, breed, and age resulted in risk factors for HC. Mean (± SD) age for dogs with HC was 9.8 (± 2.5) yr. Females had higher risk for HC compared to males (OR 1.85; 95% CI, 1.24–2.75); all neutered dogs (both males and females) had higher risk than intact dogs (OR 2.54; 95% CI, 1.72–3.73); and neutered females had higher risk compared to intact females (OR 2.61; 95% CI, 1.54–4.42). Using the mixed breed dogs as a control population (OR = 1), the risk of developing HC was significantly higher in the Standard Schnauzer (OR 58.1; p < 0.0001) and Fox Terrier (OR 20.33; p < 0.0001). With regard to HC, this study identified an overall prevalence of 0.20%. The data support the existence of sex predisposition, with the highest risk for neutered females.
Collapse
Affiliation(s)
- Gaia Carotenuto
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Bologna 40064, Italy
| | - Eleonora Malerba
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Bologna 40064, Italy
| | - Costanza Dolfini
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Bologna 40064, Italy
| | - Francesca Brugnoli
- Ospedale Veterinario I Portoni Rossi, Zola Predosa, Bologna 40069, Italy
| | | | | | | | - Federico Fracassi
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Bologna 40064, Italy
| |
Collapse
|
6
|
Tokumoto M, Onoda N, Tauchi Y, Kashiwagi S, Noda S, Toi N, Kurajoh M, Ohsawa M, Yamazaki Y, Sasano H, Hirakawa K, Ohira M. A case of Adrenocoricotrophic hormone -independent bilateral adrenocortical macronodular hyperplasia concomitant with primary aldosteronism. BMC Surg 2017; 17:97. [PMID: 28877721 PMCID: PMC5585945 DOI: 10.1186/s12893-017-0293-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 08/28/2017] [Indexed: 11/10/2022] Open
Abstract
Background Adrenocoricotrophic hormone (ACTH) – independent bilateral adrenocortical macronodular hyperplasia (AIMAH) is a rare cause of Cushing’s syndrome, and is characterized by bilateral adrenal hyperplasia. However, Primary aldosteronism (PA) is a relatively common adrenal disease. Case presentation A 56-year-old man who has been treated hypertension and diabetes mellitus was detected low plasma potassium level with an elevated level of plasma aldosterone concentration and bilateral adrenal swelling. Endocrinological examinations showed autonomous secretion of cortisol and aldosterone, with suppression of plasma ACTH level and renin activity. A selective adrenal venous sampling demonstrated that left adrenal gland was responsible for aldosterone hypersecretion. He was diagnosed preclinical Cushing’s syndrome due to ACTH – independent bilateral adrenocortical macronodular hyperplasia (AIMAH) associated with aldosterone producing adenoma of the left adrenal gland. A laparoscopic left adrenalectomy was performed. Conclusion The resected adrenal specimen histologically consisted with a diagnosis of AIMAH. Moreover, tiny cell clusters positive immunostaining for aldosterone synthase was revealed. This is a rare case of AIMAH accompanied by preclinical Cushing’s syndrome and primary aldosteronism.
Collapse
Affiliation(s)
- Mao Tokumoto
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Naoyoshi Onoda
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Yukie Tauchi
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Shinichiro Kashiwagi
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Satoru Noda
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Norikazu Toi
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masahumi Kurajoh
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masahiko Ohsawa
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuto Yamazaki
- Department of Anatomic Pathology, Tohoku University Graduate school of Medicine, Sendai, Japan
| | - Hironobu Sasano
- Department of Anatomic Pathology, Tohoku University Graduate school of Medicine, Sendai, Japan
| | - Kosei Hirakawa
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masaichi Ohira
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| |
Collapse
|
7
|
Carré J, Grunenwald S, Vezzosi D, Mazerolles C, Bennet A, Meduri G, Caron P. Virilizing oncocytic adrenocortical carcinoma: clinical and immunohistochemical studies. Gynecol Endocrinol 2016; 32:662-666. [PMID: 26954035 DOI: 10.3109/09513590.2016.1149811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Oncocytic tumors of the adrenal cortex are rare, mostly nonfunctioning and benign. SETTING Report virilizing oncocytic adrenocortical carcinoma in a 50-year-old woman. PATIENT She presented a recent and progressive virilization syndrome, associated with high blood pressure. Hormonal evaluation showed elevated serum testosterone and delta-4-androstenedione levels, normal urinary free cortisol level and incomplete suppression of cortisol at the 1 mg dexamethasone suppression test. CT scan of the abdomen revealed a 35 mm left adrenal mass. INTERVENTION The patient underwent a left adrenalectomy, and the histological study showed a 3 cm oncocytic adrenocortical carcinoma with signs of malignancy. RESULTS Immunohistochemical study revealed that tumor cells expressed the steroidogenic enzymes involved into androgen synthesis (3βHSD and P450c17α), P450 aromatase and luteinizing hormone (LH) receptors. Post-operatively, signs of virilization improved rapidly, serum testosterone and delta-4-androstenedione levels returned to normal, as did the dexamethasone suppression test. During follow-up CT-scan and 18-FDG PET/CT showed a right ovary mass, corresponding to a follicular cyst associated with hyperthecosis. The patient is alive with no recurrence 48 months after adrenal surgery. CONCLUSION Oncocytic adrenocortical carcinomas, although extremely rare, should be considered in women with a virilization syndrome. In this woman immunohistochimical studies revealed the presence of steroidogenic enzymes involved into androgen synthesis and aromatization, and LH receptors could be implicated in this pathology.
Collapse
Affiliation(s)
- Julie Carré
- a Department of Endocrinology and Metabolic Diseases , Pôle Cardio-Vasculaire Et Métabolique, CHU Larrey , Toulouse , France
| | - Solange Grunenwald
- a Department of Endocrinology and Metabolic Diseases , Pôle Cardio-Vasculaire Et Métabolique, CHU Larrey , Toulouse , France
| | - Delphine Vezzosi
- a Department of Endocrinology and Metabolic Diseases , Pôle Cardio-Vasculaire Et Métabolique, CHU Larrey , Toulouse , France
| | | | - Antoine Bennet
- a Department of Endocrinology and Metabolic Diseases , Pôle Cardio-Vasculaire Et Métabolique, CHU Larrey , Toulouse , France
| | | | - Philippe Caron
- a Department of Endocrinology and Metabolic Diseases , Pôle Cardio-Vasculaire Et Métabolique, CHU Larrey , Toulouse , France
| |
Collapse
|
8
|
Basham KJ, Hung HA, Lerario AM, Hammer GD. Mouse models of adrenocortical tumors. Mol Cell Endocrinol 2016; 421:82-97. [PMID: 26678830 PMCID: PMC4720156 DOI: 10.1016/j.mce.2015.11.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 12/17/2022]
Abstract
The molecular basis of the organogenesis, homeostasis, and tumorigenesis of the adrenal cortex has been the subject of intense study for many decades. Specifically, characterization of tumor predisposition syndromes with adrenocortical manifestations and molecular profiling of sporadic adrenocortical tumors have led to the discovery of key molecular pathways that promote pathological adrenal growth. However, given the observational nature of such studies, several important questions regarding the molecular pathogenesis of adrenocortical tumors have remained. This review will summarize naturally occurring and genetically engineered mouse models that have provided novel tools to explore the molecular and cellular underpinnings of adrenocortical tumors. New paradigms of cancer initiation, maintenance, and progression that have emerged from this work will be discussed.
Collapse
Affiliation(s)
- Kaitlin J Basham
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, USA; Endocrine Oncology Program, Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Holly A Hung
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, USA; Endocrine Oncology Program, Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Antonio M Lerario
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, USA; Endocrine Oncology Program, Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Gary D Hammer
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, USA; Endocrine Oncology Program, Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, 48109, USA.
| |
Collapse
|
9
|
Villares Fragoso MCB, Wanichi IQ, Cavalcante IP, Mariani BMDP. The Role of gsp Mutations on the Development of Adrenocortical Tumors and Adrenal Hyperplasia. Front Endocrinol (Lausanne) 2016; 7:104. [PMID: 27512387 PMCID: PMC4962502 DOI: 10.3389/fendo.2016.00104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/12/2016] [Indexed: 01/18/2023] Open
Abstract
Somatic GNAS point mutations, commonly known as gsp mutations, are involved in the pathogenesis of McCune-Albright syndrome (MAS) and have also been described in autonomous hormone-producing tumors, such as somatotropinoma, corticotrophoma, thyroid cancer, ovarian and testicular Leydig cell tumors, and primary macronodular adrenocortical hyperplasia (PMAH) (1-3). The involvement of gsp mutations in adrenal tumors was first described by Lyons et al. Since then, several studies have detected the presence of gsp mutations in adrenal tumors, but none of them could explain its presence along or the mechanism that leads to tumor formation and hormone hypersecretion. As a result, the molecular pathogenesis of the majority of sporadic adrenocortical tumors remains unclear (3). PMAH has also been reported with gsp somatic mutations in a few cases. Fragoso et al. identified two distinct gsp somatic mutations affecting arginine residues on codon 201 of GNAS in a few patients with PMAH who lacked any features or manifestations of MAS. Followed by this discovery, other studies have continued looking for gsp mutations based on strong prior evidence demonstrating that increased cAMP signaling is sufficient for cell proliferation and cortisol production (2, 4). With consideration for the previously reported findings, we conjecture that although somatic activating mutations in GNAS are a rare molecular event, these mutations could probably be sufficient to induce the development of macronodule hyperplasia and variable cortisol secretion. In this manuscript, we revised the presence of gsp mutations associated with adrenal cortical tumors and hyperplasia.
Collapse
Affiliation(s)
- Maria Candida Barisson Villares Fragoso
- Unidade de Suprarrenal, Disciplina de Endocrinologia e Metabologia, Laboratorio de Hormonios e Genetica Molecular LIM/42, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
- *Correspondence: Maria Candida Barisson Villares Fragoso,
| | - Ingrid Quevedo Wanichi
- Unidade de Suprarrenal, Disciplina de Endocrinologia e Metabologia, Laboratorio de Hormonios e Genetica Molecular LIM/42, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Isadora Pontes Cavalcante
- Unidade de Suprarrenal, Disciplina de Endocrinologia e Metabologia, Laboratorio de Hormonios e Genetica Molecular LIM/42, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Beatriz Marinho de Paula Mariani
- Unidade de Suprarrenal, Disciplina de Endocrinologia e Metabologia, Laboratorio de Hormonios e Genetica Molecular LIM/42, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
10
|
Albiger NM, Ceccato F, Zilio M, Barbot M, Occhi G, Rizzati S, Fassina A, Mantero F, Boscaro M, Iacobone M, Scaroni C. An analysis of different therapeutic options in patients with Cushing's syndrome due to bilateral macronodular adrenal hyperplasia: a single-centre experience. Clin Endocrinol (Oxf) 2015; 82:808-15. [PMID: 25727927 DOI: 10.1111/cen.12763] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 11/09/2014] [Accepted: 02/24/2015] [Indexed: 12/30/2022]
Abstract
CONTEXT Bilateral macronodular adrenal hyperplasia (BMAH) is a rare form of Cushing's syndrome (CS). A variety of in vivo tests to identify aberrant receptor expression have been proposed to guide medical treatment. Unilateral adrenalectomy (UA) may be effective in selected patients, but little is known about recurrence during follow-up. OBJECTIVE To describe a series of patients with BMAH and CS treated by different approaches, with a particular focus on the benefit of UA. DESIGN AND PATIENTS We retrospectively assessed 16 patients with BMAH and CS (11 females, five males), analysing the in vivo cortisol response to different provocative tests. Twelve of the 16 patients underwent UA and were monitored over the long term. RESULTS Based on in vivo test results, octreotide LAR or propranolol was administered in one case of food-dependent CS and two patients with a positive postural test. A significant improvement in biochemical values was seen in all patients but with limited clinical response. UA was performed in 12 patients, producing long-term remission in three (106 ± 28 months; range: 80-135), recurrence in eight (after 54 ± 56 months; range 12-180) and persistence in one other. Four patients subsequently underwent contralateral adrenalectomy for overt CS, one received ketoconazole, and four other patients remain under observation for subclinical CS. CONCLUSIONS Medical treatment based on cortisol response to provocative tests had a limited role in our patients, whereas UA was useful in some of them. Although recurrence is likely, the timing of onset is variable and close follow-up is mandatory to identify it.
Collapse
Affiliation(s)
- N M Albiger
- Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - F Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - M Zilio
- Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - M Barbot
- Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - G Occhi
- Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - S Rizzati
- Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - A Fassina
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - F Mantero
- Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - M Boscaro
- Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - M Iacobone
- Minimally Invasive Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - C Scaroni
- Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| |
Collapse
|
11
|
Marcucci G, Cianferotti L, Beck-Peccoz P, Capezzone M, Cetani F, Colao A, Davì MV, degli Uberti E, Del Prato S, Elisei R, Faggiano A, Ferone D, Foresta C, Fugazzola L, Ghigo E, Giacchetti G, Giorgino F, Lenzi A, Malandrino P, Mannelli M, Marcocci C, Masi L, Pacini F, Opocher G, Radicioni A, Tonacchera M, Vigneri R, Zatelli MC, Brandi ML. Rare diseases in clinical endocrinology: a taxonomic classification system. J Endocrinol Invest 2015; 38:193-259. [PMID: 25376364 DOI: 10.1007/s40618-014-0202-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 10/17/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE Rare endocrine-metabolic diseases (REMD) represent an important area in the field of medicine and pharmacology. The rare diseases of interest to endocrinologists involve all fields of endocrinology, including rare diseases of the pituitary, thyroid and adrenal glands, paraganglia, ovary and testis, disorders of bone and mineral metabolism, energy and lipid metabolism, water metabolism, and syndromes with possible involvement of multiple endocrine glands, and neuroendocrine tumors. Taking advantage of the constitution of a study group on REMD within the Italian Society of Endocrinology, consisting of basic and clinical scientists, a document on the taxonomy of REMD has been produced. METHODS AND RESULTS This document has been designed to include mainly REMD manifesting or persisting into adulthood. The taxonomy of REMD of the adult comprises a total of 166 main disorders, 338 including all variants and subtypes, described into 11 tables. CONCLUSIONS This report provides a complete taxonomy to classify REMD of the adult. In the future, the creation of registries of rare endocrine diseases to collect data on cohorts of patients and the development of common and standardized diagnostic and therapeutic pathways for each rare endocrine disease is advisable. This will help planning and performing intervention studies in larger groups of patients to prove the efficacy, effectiveness, and safety of a specific treatment.
Collapse
Affiliation(s)
- G Marcucci
- Head, Bone Metablic Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
| | - L Cianferotti
- Head, Bone Metablic Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - P Beck-Peccoz
- Department of Clinical Sciences and Community Health, University of Milan and Endocrine Unit, Fondazione IRCCS Ca' Granda, Milan, Italy
| | - M Capezzone
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - F Cetani
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Colao
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Naples, Italy
| | - M V Davì
- Section D, Department of Medicine, Clinic of Internal Medicine, University of Verona, Verona, Italy
| | - E degli Uberti
- Section of Endocrinology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - S Del Prato
- Section of Metabolic Diseases and Diabetes, Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy
| | - R Elisei
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Faggiano
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Naples, Italy
| | - D Ferone
- Endocrinology, Department of Internal Medicine and Medical Specialties and Center of Excellence for Biomedical Research, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - C Foresta
- Department of Medicine and Centre for Human Reproduction Pathology, University of Padova, Padua, Italy
| | - L Fugazzola
- Department of Clinical Sciences and Community Health, University of Milan and Endocrine Unit, Fondazione IRCCS Ca' Granda, Milan, Italy
| | - E Ghigo
- Division of Endocrinology, Diabetology and Metabolism Department of Medical Sciences, University Hospital Città Salute e Scienza, Turin, Italy
| | - G Giacchetti
- Division of Endocrinology, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy
| | - F Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - A Lenzi
- Chair of Endocrinology, Section Medical Pathophysiology, Food Science and Endocrinology, Department Exp. Medicine, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - P Malandrino
- Endocrinology, Department of Clinical and Molecular Biomedicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - M Mannelli
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - C Marcocci
- Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy
| | - L Masi
- Department of Orthopedic, Metabolic Bone Diseases Unit AOUC-Careggi Hospital, Largo Palagi, 1, Florence, Italy
| | - F Pacini
- Section of Endocrinology and Metabolism, University of Siena, Siena, Italy
| | - G Opocher
- Familial Cancer Clinic and Oncoendocrinology, Veneto Institute of Oncology, IRCCS, Padua, Italy
- Department of Medicine DIMED, University of Padova, Padova, Italy
| | - A Radicioni
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M Tonacchera
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - R Vigneri
- Department of Clinical and Molecular Biomedicine, University of Catania, and Humanitas Catania Center of Oncology, Catania, Italy
| | - M C Zatelli
- Section of Endocrinology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - M L Brandi
- Head, Bone Metablic Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
| |
Collapse
|
12
|
Ricciato MP, Di Donna V, Perotti G, Pontecorvi A, Bellantone R, Corsello SM. The role of adrenal scintigraphy in the diagnosis of subclinical Cushing's syndrome and the prediction of post-surgical hypoadrenalism. World J Surg 2015; 38:1328-35. [PMID: 24615601 DOI: 10.1007/s00268-014-2482-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Management of subclinical Cushing's syndrome (SCS) remains controversial; it is not possible to predict which patients would benefit from adrenalectomy. In the present study we aimed to evaluate the role of adrenocortical scintigraphy (ACS) in the management of patients with SCS. METHODS The medical records of 33 consecutive patients with adrenal "incidentaloma" and proven or suspected SCS who underwent (131)I-19-iodocholesterol ACS between 2004 and 2010 were reviewed. Sixteen underwent laparoscopic adrenalectomy (surgical group-S-group) and 17 were medically managed (medical group-M-group). Follow-up evaluation was obtained by outpatient consultation. RESULTS Overall 25 patients (15 in the S-group and 10 in the M-group) had concordant unilateral uptake at ACS (ACS+). In the S-group, the mean follow-up duration was 30.9 ± 16.1 months and, irrespective of the presence of hormonal diagnosis of SCS, in patients who were ACS+ adrenalectomy resulted in a significant increase in HDL cholesterol and decreases in body mass index, glycemia, and blood pressure (BP). One patient reduced antihypertensive medication and three others were able to discontinue it altogether. Prolonged postoperative hypoadrenalism (PH) occurred in 14 patients in the S-group. The overall accuracy in predicting PH was 93.7 % for ACS and 68.7 % for laboratory findings. In the M-group, the mean follow-up duration was 31.5 ± 26.3 months and no patient developed overt Cushing's syndrome, although ACS+ patients experienced a worsening in glycemia and diastolic BP. CONCLUSIONS Adrenal scintigraphy seems the most accurate diagnostic test for SCS. It is able to predict the metabolic outcome and the occurrence of PH, identifying the patients who could benefit from adrenalectomy irrespective of hormonal diagnosis.
Collapse
Affiliation(s)
- Maria Pia Ricciato
- Units of Endocrinology, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | | | | | | | | | | |
Collapse
|
13
|
Fragoso MCBV, Alencar GA, Lerario AM, Bourdeau I, Almeida MQ, Mendonca BB, Lacroix A. Genetics of primary macronodular adrenal hyperplasia. J Endocrinol 2015; 224:R31-43. [PMID: 25472909 DOI: 10.1530/joe-14-0568] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ACTH-independent macronodular adrenal hyperplasia is a rare cause of Cushing's syndrome (CS), accounting for <2% of all endogenous CS cases; however it is more frequently identified incidentally with sub-clinical cortisol secretion. Recently, cortisol secretion has been shown to be regulated by ectopic corticotropin, which is in turn produced by clusters of steroidogenic cells of the hyperplastic adrenal nodules. Hence, the term 'ACTH-independent' is not entirely appropriate for this disorder. Accordingly, the disease is designated primary macronodular adrenal hyperplasia (PMAH) in this review article. The means by which cortisol production is regulated in PMAH despite the suppressed levels of ACTH of pituitary origin is exceedingly complex. Several molecular events have been proposed to explain the enhanced cortisol secretion, increased cell proliferation, and nodule formation in PMAH. Nonetheless, the precise sequence of events and the molecular mechanisms underlying this condition remain unclear. The purpose of this review is therefore to present new insights on the molecular and genetic profile of PMAH pathophysiology, and to discuss the implications for disease progression.
Collapse
Affiliation(s)
- Maria Candida Barisson Villares Fragoso
- Unidade de SuprarrenalDisciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, BrazilInstituto do Câncer de São Paulo ICESPSão Paulo, BrazilDépartement de MédecineCentre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada Unidade de SuprarrenalDisciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, BrazilInstituto do Câncer de São Paulo ICESPSão Paulo, BrazilDépartement de MédecineCentre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Guilherme Asmar Alencar
- Unidade de SuprarrenalDisciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, BrazilInstituto do Câncer de São Paulo ICESPSão Paulo, BrazilDépartement de MédecineCentre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Antonio Marcondes Lerario
- Unidade de SuprarrenalDisciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, BrazilInstituto do Câncer de São Paulo ICESPSão Paulo, BrazilDépartement de MédecineCentre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Isabelle Bourdeau
- Unidade de SuprarrenalDisciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, BrazilInstituto do Câncer de São Paulo ICESPSão Paulo, BrazilDépartement de MédecineCentre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Madson Queiroz Almeida
- Unidade de SuprarrenalDisciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, BrazilInstituto do Câncer de São Paulo ICESPSão Paulo, BrazilDépartement de MédecineCentre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada Unidade de SuprarrenalDisciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, BrazilInstituto do Câncer de São Paulo ICESPSão Paulo, BrazilDépartement de MédecineCentre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Berenice Bilharinho Mendonca
- Unidade de SuprarrenalDisciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, BrazilInstituto do Câncer de São Paulo ICESPSão Paulo, BrazilDépartement de MédecineCentre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - André Lacroix
- Unidade de SuprarrenalDisciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, BrazilInstituto do Câncer de São Paulo ICESPSão Paulo, BrazilDépartement de MédecineCentre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| |
Collapse
|
14
|
Elbelt U, Trovato A, Kloth M, Gentz E, Finke R, Spranger J, Galas D, Weber S, Wolf C, König K, Arlt W, Büttner R, May P, Allolio B, Schneider JG. Molecular and clinical evidence for an ARMC5 tumor syndrome: concurrent inactivating germline and somatic mutations are associated with both primary macronodular adrenal hyperplasia and meningioma. J Clin Endocrinol Metab 2015; 100:E119-28. [PMID: 25279498 PMCID: PMC4283009 DOI: 10.1210/jc.2014-2648] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/19/2014] [Indexed: 12/26/2022]
Abstract
CONTEXT Primary macronodular adrenal hyperplasia (PMAH) is a rare cause of Cushing's syndrome, which may present in the context of different familial multitumor syndromes. Heterozygous inactivating germline mutations of armadillo repeat containing 5 (ARMC5) have very recently been described as cause for sporadic PMAH. Whether this genetic condition also causes familial PMAH in association with other neoplasias is unclear. OBJECTIVE The aim of the present study was to delineate the molecular cause in a large family with PMAH and other neoplasias. PATIENTS AND METHODS Whole-genome sequencing and comprehensive clinical and biochemical phenotyping was performed in members of a PMAH affected family. Nodules derived from adrenal surgery and pancreatic and meningeal tumor tissue were analyzed for accompanying somatic mutations in the identified target genes. RESULTS PMAH presenting either as overt or subclinical Cushing's syndrome was accompanied by a heterozygous germline mutation in ARMC5 (p.A110fs*9) located on chromosome 16. Analysis of tumor tissue showed different somatic ARMC5 mutations in adrenal nodules supporting a second hit hypothesis with inactivation of a tumor suppressor gene. A damaging somatic ARMC5 mutation was also found in a concomitant meningioma (p.R502fs) but not in a pancreatic tumor, suggesting biallelic inactivation of ARMC5 as causal also for the intracranial meningioma. CONCLUSIONS Our analysis further confirms inherited inactivating ARMC5 mutations as a cause of familial PMAH and suggests an additional role for the development of concomitant intracranial meningiomas.
Collapse
Affiliation(s)
| | - Alessia Trovato
- Department of Endocrinology, Diabetes, and Nutrition (U.E., A.T., J.S.), Department of Hepatology and Gastroenterology (E.G.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; Institute of Pathology (M.K., K.K., R.B.), University of Cologne, 50937 Cologne, Germany; Praxisgemeinschaft an der Kaisereiche (R.F.), 12159 Berlin, Germany; Luxembourg Centre for Systems Biomedicine (D.G., C.W., P.M., J.G.S.), University of Luxembourg, 4362 Luxembourg, Luxembourg; Pacific Northwest Diabetes Research Institute (D.G.), Seattle, Washington 98122; Department of Internal Medicine II (S.W., C.W.), Saarland University Medical Center, 66421 Homburg/Saar, Germany; Centre for Endocrinology, Diabetes, and Metabolism (W.A.), School of Clinical and Experimental Medicine, University of Birmingham, Birmingham B15 2TT, United Kingdom; Family Genomes Group (P.M.), Institute for Systems Biology, Seattle, Washington 98109; and Department of Internal Medicine I (B.A.), Endocrine and Diabetes Unit, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Michael Kloth
- Department of Endocrinology, Diabetes, and Nutrition (U.E., A.T., J.S.), Department of Hepatology and Gastroenterology (E.G.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; Institute of Pathology (M.K., K.K., R.B.), University of Cologne, 50937 Cologne, Germany; Praxisgemeinschaft an der Kaisereiche (R.F.), 12159 Berlin, Germany; Luxembourg Centre for Systems Biomedicine (D.G., C.W., P.M., J.G.S.), University of Luxembourg, 4362 Luxembourg, Luxembourg; Pacific Northwest Diabetes Research Institute (D.G.), Seattle, Washington 98122; Department of Internal Medicine II (S.W., C.W.), Saarland University Medical Center, 66421 Homburg/Saar, Germany; Centre for Endocrinology, Diabetes, and Metabolism (W.A.), School of Clinical and Experimental Medicine, University of Birmingham, Birmingham B15 2TT, United Kingdom; Family Genomes Group (P.M.), Institute for Systems Biology, Seattle, Washington 98109; and Department of Internal Medicine I (B.A.), Endocrine and Diabetes Unit, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Enno Gentz
- Department of Endocrinology, Diabetes, and Nutrition (U.E., A.T., J.S.), Department of Hepatology and Gastroenterology (E.G.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; Institute of Pathology (M.K., K.K., R.B.), University of Cologne, 50937 Cologne, Germany; Praxisgemeinschaft an der Kaisereiche (R.F.), 12159 Berlin, Germany; Luxembourg Centre for Systems Biomedicine (D.G., C.W., P.M., J.G.S.), University of Luxembourg, 4362 Luxembourg, Luxembourg; Pacific Northwest Diabetes Research Institute (D.G.), Seattle, Washington 98122; Department of Internal Medicine II (S.W., C.W.), Saarland University Medical Center, 66421 Homburg/Saar, Germany; Centre for Endocrinology, Diabetes, and Metabolism (W.A.), School of Clinical and Experimental Medicine, University of Birmingham, Birmingham B15 2TT, United Kingdom; Family Genomes Group (P.M.), Institute for Systems Biology, Seattle, Washington 98109; and Department of Internal Medicine I (B.A.), Endocrine and Diabetes Unit, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Reinhard Finke
- Department of Endocrinology, Diabetes, and Nutrition (U.E., A.T., J.S.), Department of Hepatology and Gastroenterology (E.G.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; Institute of Pathology (M.K., K.K., R.B.), University of Cologne, 50937 Cologne, Germany; Praxisgemeinschaft an der Kaisereiche (R.F.), 12159 Berlin, Germany; Luxembourg Centre for Systems Biomedicine (D.G., C.W., P.M., J.G.S.), University of Luxembourg, 4362 Luxembourg, Luxembourg; Pacific Northwest Diabetes Research Institute (D.G.), Seattle, Washington 98122; Department of Internal Medicine II (S.W., C.W.), Saarland University Medical Center, 66421 Homburg/Saar, Germany; Centre for Endocrinology, Diabetes, and Metabolism (W.A.), School of Clinical and Experimental Medicine, University of Birmingham, Birmingham B15 2TT, United Kingdom; Family Genomes Group (P.M.), Institute for Systems Biology, Seattle, Washington 98109; and Department of Internal Medicine I (B.A.), Endocrine and Diabetes Unit, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Joachim Spranger
- Department of Endocrinology, Diabetes, and Nutrition (U.E., A.T., J.S.), Department of Hepatology and Gastroenterology (E.G.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; Institute of Pathology (M.K., K.K., R.B.), University of Cologne, 50937 Cologne, Germany; Praxisgemeinschaft an der Kaisereiche (R.F.), 12159 Berlin, Germany; Luxembourg Centre for Systems Biomedicine (D.G., C.W., P.M., J.G.S.), University of Luxembourg, 4362 Luxembourg, Luxembourg; Pacific Northwest Diabetes Research Institute (D.G.), Seattle, Washington 98122; Department of Internal Medicine II (S.W., C.W.), Saarland University Medical Center, 66421 Homburg/Saar, Germany; Centre for Endocrinology, Diabetes, and Metabolism (W.A.), School of Clinical and Experimental Medicine, University of Birmingham, Birmingham B15 2TT, United Kingdom; Family Genomes Group (P.M.), Institute for Systems Biology, Seattle, Washington 98109; and Department of Internal Medicine I (B.A.), Endocrine and Diabetes Unit, University Hospital Würzburg, 97080 Würzburg, Germany
| | - David Galas
- Department of Endocrinology, Diabetes, and Nutrition (U.E., A.T., J.S.), Department of Hepatology and Gastroenterology (E.G.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; Institute of Pathology (M.K., K.K., R.B.), University of Cologne, 50937 Cologne, Germany; Praxisgemeinschaft an der Kaisereiche (R.F.), 12159 Berlin, Germany; Luxembourg Centre for Systems Biomedicine (D.G., C.W., P.M., J.G.S.), University of Luxembourg, 4362 Luxembourg, Luxembourg; Pacific Northwest Diabetes Research Institute (D.G.), Seattle, Washington 98122; Department of Internal Medicine II (S.W., C.W.), Saarland University Medical Center, 66421 Homburg/Saar, Germany; Centre for Endocrinology, Diabetes, and Metabolism (W.A.), School of Clinical and Experimental Medicine, University of Birmingham, Birmingham B15 2TT, United Kingdom; Family Genomes Group (P.M.), Institute for Systems Biology, Seattle, Washington 98109; and Department of Internal Medicine I (B.A.), Endocrine and Diabetes Unit, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Susanne Weber
- Department of Endocrinology, Diabetes, and Nutrition (U.E., A.T., J.S.), Department of Hepatology and Gastroenterology (E.G.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; Institute of Pathology (M.K., K.K., R.B.), University of Cologne, 50937 Cologne, Germany; Praxisgemeinschaft an der Kaisereiche (R.F.), 12159 Berlin, Germany; Luxembourg Centre for Systems Biomedicine (D.G., C.W., P.M., J.G.S.), University of Luxembourg, 4362 Luxembourg, Luxembourg; Pacific Northwest Diabetes Research Institute (D.G.), Seattle, Washington 98122; Department of Internal Medicine II (S.W., C.W.), Saarland University Medical Center, 66421 Homburg/Saar, Germany; Centre for Endocrinology, Diabetes, and Metabolism (W.A.), School of Clinical and Experimental Medicine, University of Birmingham, Birmingham B15 2TT, United Kingdom; Family Genomes Group (P.M.), Institute for Systems Biology, Seattle, Washington 98109; and Department of Internal Medicine I (B.A.), Endocrine and Diabetes Unit, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Cristina Wolf
- Department of Endocrinology, Diabetes, and Nutrition (U.E., A.T., J.S.), Department of Hepatology and Gastroenterology (E.G.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; Institute of Pathology (M.K., K.K., R.B.), University of Cologne, 50937 Cologne, Germany; Praxisgemeinschaft an der Kaisereiche (R.F.), 12159 Berlin, Germany; Luxembourg Centre for Systems Biomedicine (D.G., C.W., P.M., J.G.S.), University of Luxembourg, 4362 Luxembourg, Luxembourg; Pacific Northwest Diabetes Research Institute (D.G.), Seattle, Washington 98122; Department of Internal Medicine II (S.W., C.W.), Saarland University Medical Center, 66421 Homburg/Saar, Germany; Centre for Endocrinology, Diabetes, and Metabolism (W.A.), School of Clinical and Experimental Medicine, University of Birmingham, Birmingham B15 2TT, United Kingdom; Family Genomes Group (P.M.), Institute for Systems Biology, Seattle, Washington 98109; and Department of Internal Medicine I (B.A.), Endocrine and Diabetes Unit, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Katharina König
- Department of Endocrinology, Diabetes, and Nutrition (U.E., A.T., J.S.), Department of Hepatology and Gastroenterology (E.G.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; Institute of Pathology (M.K., K.K., R.B.), University of Cologne, 50937 Cologne, Germany; Praxisgemeinschaft an der Kaisereiche (R.F.), 12159 Berlin, Germany; Luxembourg Centre for Systems Biomedicine (D.G., C.W., P.M., J.G.S.), University of Luxembourg, 4362 Luxembourg, Luxembourg; Pacific Northwest Diabetes Research Institute (D.G.), Seattle, Washington 98122; Department of Internal Medicine II (S.W., C.W.), Saarland University Medical Center, 66421 Homburg/Saar, Germany; Centre for Endocrinology, Diabetes, and Metabolism (W.A.), School of Clinical and Experimental Medicine, University of Birmingham, Birmingham B15 2TT, United Kingdom; Family Genomes Group (P.M.), Institute for Systems Biology, Seattle, Washington 98109; and Department of Internal Medicine I (B.A.), Endocrine and Diabetes Unit, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Wiebke Arlt
- Department of Endocrinology, Diabetes, and Nutrition (U.E., A.T., J.S.), Department of Hepatology and Gastroenterology (E.G.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; Institute of Pathology (M.K., K.K., R.B.), University of Cologne, 50937 Cologne, Germany; Praxisgemeinschaft an der Kaisereiche (R.F.), 12159 Berlin, Germany; Luxembourg Centre for Systems Biomedicine (D.G., C.W., P.M., J.G.S.), University of Luxembourg, 4362 Luxembourg, Luxembourg; Pacific Northwest Diabetes Research Institute (D.G.), Seattle, Washington 98122; Department of Internal Medicine II (S.W., C.W.), Saarland University Medical Center, 66421 Homburg/Saar, Germany; Centre for Endocrinology, Diabetes, and Metabolism (W.A.), School of Clinical and Experimental Medicine, University of Birmingham, Birmingham B15 2TT, United Kingdom; Family Genomes Group (P.M.), Institute for Systems Biology, Seattle, Washington 98109; and Department of Internal Medicine I (B.A.), Endocrine and Diabetes Unit, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Reinhard Büttner
- Department of Endocrinology, Diabetes, and Nutrition (U.E., A.T., J.S.), Department of Hepatology and Gastroenterology (E.G.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; Institute of Pathology (M.K., K.K., R.B.), University of Cologne, 50937 Cologne, Germany; Praxisgemeinschaft an der Kaisereiche (R.F.), 12159 Berlin, Germany; Luxembourg Centre for Systems Biomedicine (D.G., C.W., P.M., J.G.S.), University of Luxembourg, 4362 Luxembourg, Luxembourg; Pacific Northwest Diabetes Research Institute (D.G.), Seattle, Washington 98122; Department of Internal Medicine II (S.W., C.W.), Saarland University Medical Center, 66421 Homburg/Saar, Germany; Centre for Endocrinology, Diabetes, and Metabolism (W.A.), School of Clinical and Experimental Medicine, University of Birmingham, Birmingham B15 2TT, United Kingdom; Family Genomes Group (P.M.), Institute for Systems Biology, Seattle, Washington 98109; and Department of Internal Medicine I (B.A.), Endocrine and Diabetes Unit, University Hospital Würzburg, 97080 Würzburg, Germany
| | | | | | | |
Collapse
|
15
|
Rhee H, Jeon YK, Kim SS, Kang YH, Son SM, Kim YK, Kim IJ. Adrenocorticotropic hormone-independent macronodular adrenal hyperplasia with abnormal cortisol secretion mediated by catecholamines. Korean J Intern Med 2014; 29:667-70. [PMID: 25228844 PMCID: PMC4164732 DOI: 10.3904/kjim.2014.29.5.667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 05/19/2014] [Accepted: 06/23/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Harin Rhee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Yun Kyung Jeon
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Sang Soo Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Yang Ho Kang
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Seok Man Son
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Yong Ki Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - In Joo Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| |
Collapse
|
16
|
Kooistra HS, Galac S. Recent advances in the diagnosis of Cushing's syndrome in dogs. Top Companion Anim Med 2012; 27:21-4. [PMID: 22958793 DOI: 10.1053/j.tcam.2012.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hypercortisolism is a common condition in dogs and can be defined as the physical and biochemical changes that result from prolonged exposure to inappropriately high plasma concentrations of (free) cortisol, whatever its' cause. This disorder is often called Cushing's syndrome, after Harvey Cushing, the neurosurgeon who first described the human syndrome in 1932.
Collapse
Affiliation(s)
- Hans S Kooistra
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands.
| | | |
Collapse
|
17
|
Nozaki T, Iida Y, Morii A, Fujiuchi Y, Suzuki H, Okazawa M, Iwata M, Fuse H. Results of unilateral adrenalectomy in subclinical Cushing's syndrome due to adrenocorticotropic hormone-independent macronodular adrenal hyperplasia. SURGICAL PRACTICE 2012. [DOI: 10.1111/j.1744-1633.2012.00614.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tetsuo Nozaki
- Department of Urology; Graduate School of Medicine and Pharmaceutical Sciences for Research; University of Toyama; Toyama; Japan
| | - Yasuhiro Iida
- Department of Urology; Graduate School of Medicine and Pharmaceutical Sciences for Research; University of Toyama; Toyama; Japan
| | - Akihiro Morii
- Department of Urology; Graduate School of Medicine and Pharmaceutical Sciences for Research; University of Toyama; Toyama; Japan
| | - Yasuyoshi Fujiuchi
- Department of Urology; Graduate School of Medicine and Pharmaceutical Sciences for Research; University of Toyama; Toyama; Japan
| | - Hikaru Suzuki
- First Department of Medicine; Graduate School of Medicine and Pharmaceutical Sciences for Research; University of Toyama; Toyama; Japan
| | - Mitsuyo Okazawa
- First Department of Medicine; Graduate School of Medicine and Pharmaceutical Sciences for Research; University of Toyama; Toyama; Japan
| | - Minoru Iwata
- First Department of Medicine; Graduate School of Medicine and Pharmaceutical Sciences for Research; University of Toyama; Toyama; Japan
| | - Hideki Fuse
- Department of Urology; Graduate School of Medicine and Pharmaceutical Sciences for Research; University of Toyama; Toyama; Japan
| |
Collapse
|
18
|
Vassiliadi DA, Ntali G, Stratigou T, Adali M, Tsagarakis S. Aberrant cortisol responses to physiological stimuli in patients presenting with bilateral adrenal incidentalomas. Endocrine 2011; 40:437-44. [PMID: 21598069 DOI: 10.1007/s12020-011-9490-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 05/10/2011] [Indexed: 11/30/2022]
Abstract
Aberrant receptors have been implicated in the pathogenesis of several types of adrenal tumours. So far the presence of aberrant receptors has been investigated in patients with massively enlarged adrenals due to ACTH-independent macronodular adrenal hyperplasia (AIMAH) and unilateral adrenal adenomas associated with overt or subclinical Cushing's syndrome. The likelihood of aberrant responses in patients presenting with bilateral adrenal incidentalomas (BI) presenting as discrete solitary bilateral adenomas has not been thoroughly addressed. This is an observational cross-sectional prospective study conducted in a secondary/tertiary care centre. We studied 33 patients; 28 with incidentally discovered bilateral discrete adrenal adenomas and five with massive bilateral adrenal macronodular hyperplasia. We probed responses to physiological stimuli, namely upright posture and meal; in a subgroup of menopausal women the presence of aberrant gonadotropin receptors was assessed by the LHRH test. Abnormal responses obtained in tests performed with no dexamethasone suppression were always repeated and confirmed under dexamethasone suppression. Aberrant cortisol responses were confirmed in 10 patients; 9 to posture, 1 to meal (along with a positive response to posture) and 1 to LHRH tests. Patients who responded to any test compared to those who tested negative had larger adenomas, higher post-LDDST and midnight cortisol and a trend for lower ACTH levels. Patients without subclinical hypercortisolism (SH) did not respond to any test while 50% of patients with SH had an aberrant response (P = 0.002). A greater prevalence of aberrant responses was noted in patients with bilateral macronodular hyperplasia compared to those with solitary bilateral adenomas (80 vs. 21.4%, P = 0.02). Aberrant cortisol responses, primarily to posture testing, are present in a substantial proportion of patients with bilateral adrenal incidentalomas. Such cortisol responses are observed only in patients with subclinical hypercortisolism and especially in those patients with larger adrenal lesions.
Collapse
|
19
|
Androulakis II, Kaltsas GA, Markou A, Tseniklidi E, Kafritsa P, Pappa T, Papanastasiou L, Piaditis GP. The functional status of incidentally discovered bilateral adrenal lesions. Clin Endocrinol (Oxf) 2011; 75:44-9. [PMID: 21521282 DOI: 10.1111/j.1365-2265.2011.04013.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate autonomous cortisol and aldosterone secretion and insulin resistance (IR) indices, in patients with incidentally discovered bilateral adrenal lesions (BA). PATIENTS Thirty-six patients with BA, 113 patients with unilateral adrenal incidentalomas (UA) and 89 healthy subjects (C) with normal adrenal imaging. MEASUREMENTS All participants underwent adrenal imaging, baseline biochemical and hormonal measurements and the following investigations on consecutive days: (i) A 2-h oral glucose tolerance test (OGTT) (75 g) with glucose and insulin measurements every 30 min. (ii) An adrenocorticotrophin (ACTH) stimulation test with intravenous (i.v.) bolus administration of 250 μg of ACTH (1-24) and measurement of serum cortisol and aldosterone before and after 30 and 60 min. (iii) A low-dose dexamethasone suppression test (LDDST) (0·5 mg of dexamethasone every 6-h for 2 days) with cortisol measurement 6 h after the last dexamethasone dose and (iv) A NaCl (0·9%) postdexamethasone saline infusion test (PD-SIT) (2 l of NaCl 0·9% iv in 4 h) following the LDDST, with aldosterone measurement at the end of the test. RESULTS Cortisol and aldosterone cut-offs based on the mean + 2 SD values obtained from the C group following the LDDST and PD-SITs were calculated (34·11 nm and 74·83 pm, respectively). Based on the above cut-offs, autonomous cortisol and aldosterone secretion was found in 42·5 and 15·9% of patients with UA, and in 41·7 and 19·4% of patients with BA, respectively. In addition, 17·7% of patients with UA and 19·4% of patients with BA had concomitant autonomous cortisol and aldosterone secretion. Cortisol and aldosterone levels following the LDDST and PD-SIT were significantly higher in the BA compared to the UA group, respectively. Furthermore, patients with BA had more pronounced glucose levels and insulin resistance (IR) indices compared to patients with UA. CONCLUSIONS Patients with BA have more pronounced autonomous cortisol and aldosterone secretion and glucose metabolism alterations than patients with UA. Further studies are needed to evaluate the potential long-term consequences of these findings.
Collapse
Affiliation(s)
- Ioannis I Androulakis
- Department of Endocrinology and Diabetes, General Hospital of Athens "G. Genimatas"Department of Pathophysiology, Endocrine Unit, Medical School, University of Athens, Athens, Greece
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Recent Advances in the Diagnosis of Cushing's Syndrome in Dogs. Vet Clin North Am Small Anim Pract 2010; 40:259-67. [DOI: 10.1016/j.cvsm.2009.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
21
|
Louiset E, Gobet F, Libé R, Horvath A, Renouf S, Cariou J, Rothenbuhler A, Bertherat J, Clauser E, Grise P, Stratakis CA, Kuhn JM, Lefebvre H. ACTH-independent Cushing's syndrome with bilateral micronodular adrenal hyperplasia and ectopic adrenocortical adenoma. J Clin Endocrinol Metab 2010; 95:18-24. [PMID: 19915020 PMCID: PMC2805485 DOI: 10.1210/jc.2009-0881] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Bilateral micronodular adrenal hyperplasia and ectopic adrenocortical adenoma are two rare causes of ACTH-independent Cushing's syndrome. OBJECTIVE The aim of the study was to evaluate a 35-yr-old woman with ACTH-independent hypercortisolism associated with both micronodular adrenal hyperplasia and ectopic pararenal adrenocortical adenoma. DESIGN AND SETTING In vivo and in vitro studies were performed in a University Hospital Department and academic research laboratories. INTERVENTION Mutations of the PRKAR1A, PDE8B, and PDE11A genes were searched for in leukocytes and adrenocortical tissues. The ability of adrenal and adenoma tissues to synthesize cortisol was investigated by immunohistochemistry, quantitative PCR, and/or cell culture studies. MAIN OUTCOME MEASURE Detection of 17alpha-hydroxylase and 21-hydroxylase immunoreactivities, quantification of CYP11B1 mRNA in adrenal and adenoma tissues, and measurement of cortisol levels in supernatants by radioimmunological assays were the main outcomes. RESULTS Histological examination of the adrenals revealed nonpigmented micronodular cortical hyperplasia associated with relative atrophy of internodular cortex. No genomic and/or somatic adrenal mutations of the PRKAR1A, PDE8B, and PDE11A genes were detected. 17alpha-Hydroxylase and 21-hydroxylase immunoreactivities as well as CYP11B1 mRNA were detected in adrenal and adenoma tissues. ACTH and dexamethasone activated cortisol secretion from adenoma cells. The stimulatory action of dexamethasone was mediated by a nongenomic effect involving the protein kinase A pathway. CONCLUSION This case suggests that unknown molecular defects can favor both micronodular adrenal hyperplasia and ectopic adrenocortical adenoma associated with Cushing's syndrome.
Collapse
Affiliation(s)
- Estelle Louiset
- Institut National de la Santé et de la Recherche Médicale, Unité 982/Equipe Associée 4310, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institut Fédératif de Recherches Multidisciplinaires sur les Peptides 23, University of Rouen, 76821 Mont-Saint-Aignan, France
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Hsiao HP, Kirschner LS, Bourdeau I, Keil MF, Boikos SA, Verma S, Robinson-White AJ, Nesterova M, Lacroix A, Stratakis CA. Clinical and genetic heterogeneity, overlap with other tumor syndromes, and atypical glucocorticoid hormone secretion in adrenocorticotropin-independent macronodular adrenal hyperplasia compared with other adrenocortical tumors. J Clin Endocrinol Metab 2009; 94:2930-7. [PMID: 19509103 PMCID: PMC2730864 DOI: 10.1210/jc.2009-0516] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE ACTH-independent macronodular adrenal hyperplasia (AIMAH) is often associated with subclinical cortisol secretion or atypical Cushing's syndrome (CS). We characterized a large series of patients of AIMAH and compared them with patients with other adrenocortical tumors. DESIGN AND PATIENTS We recruited 82 subjects with: 1) AIMAH (n = 16); 2) adrenocortical cortisol-producing adenoma with CS (n = 15); 3) aldosterone-producing adenoma (n = 19); and 4) single adenomas with clinically nonsignificant cortisol secretion (n = 32). METHODS Urinary free cortisol (UFC) and 17-hydroxycorticosteroid (17OHS) were collected at baseline and during dexamethasone testing; aberrant receptor responses was also sought by clinical testing and confirmed molecularly. Peripheral and/or tumor DNA was sequenced for candidate genes. RESULTS AIMAH patients had the highest 17OHS excretion, even when UFCs were within or close to the normal range. Aberrant receptor expression was highly prevalent. Histology showed at least two subtypes of AIMAH. For three patients with AIMAH, there was family history of CS; germline mutations were identified in three other patients in the genes for menin (one), fumarate hydratase (one), and adenomatosis polyposis coli (APC) (one); a PDE11A gene variant was found in another. One patient had a GNAS mutation in adrenal nodules only. There were no mutations in any of the tested genes in the patients of the other groups. CONCLUSIONS AIMAH is a clinically and genetically heterogeneous disorder that can be associated with various genetic defects and aberrant hormone receptors. It is frequently associated with atypical CS and increased 17OHS; UFCs and other measures of adrenocortical activity can be misleadingly normal.
Collapse
Affiliation(s)
- Hui-Pin Hsiao
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics, National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Mazzuco TL, Bourdeau I, Lacroix A. Adrenal incidentalomas and subclinical Cushing's syndrome: diagnosis and treatment. Curr Opin Endocrinol Diabetes Obes 2009; 16:203-10. [PMID: 19390321 DOI: 10.1097/med.0b013e32832b7043] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Adrenal incidentaloma has become a frequent clinical dilemma. Even in the absence of specific clinical features of Cushing's syndrome, adrenocortical incidentalomas may display steroid secretory activity at different degrees. The recognition of endocrine and metabolic dysfunctions associated with subclinical hypercortisolism leads to current awareness about its potential consequences. RECENT FINDINGS Different protocols and threshold values to define normal cortisol secretion and diagnosis of subclinical Cushing's syndrome have been proposed, including recent practice guidelines for the diagnosis of overt Cushing's syndrome. Follow-up studies have provided additional data about the natural course of the disease and related cardiovascular and metabolic consequences. The study of bilateral adrenocorticotropin-independent macronodular adrenocortical hyperplasia in some familial cases offers a new approach to understanding the spectrum of subclinical cortisol hypersecretion. SUMMARY The prevalence of subclinical hypercortisolism may be higher than previously reported as more sensitive diagnostic criteria are now recommended. The absence of a single gold standard test, the diversity of diagnostic criteria and the requirement of subsequent meticulous biochemical evaluations before a decision for treatment represent a challenge for the clinical management of this condition.
Collapse
Affiliation(s)
- Tânia Longo Mazzuco
- Division of Endocrinology, Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Québec, Canada
| | | | | |
Collapse
|
24
|
|
25
|
Zwermann O, Suttmann Y, Bidlingmaier M, Beuschlein F, Reincke M. Screening for membrane hormone receptor expression in primary aldosteronism. Eur J Endocrinol 2009; 160:443-51. [PMID: 19131502 DOI: 10.1530/eje-08-0711] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The investigation of expression and functional relevance of G-protein coupled receptors in primary aldosteronism (PA) by molecular and clinical studies. PATIENTS AND METHODS Tissues of 14 aldosterone-producing adenomas (APA), of one unilateral adrenal hyperplasia and of six healthy adult adrenal glands; 12 patients with confirmed PA due to APA; (n=5), idiopathic hyperaldosteronism (n=7) and 8 control subjects (C). The tissues were subjected to a quantitative PCR for determination of mRNA expression levels of AT2R1, GIPR, MC2R, GnRHR, LHR, TRHR, TSHR, glucagon-R, V1aR, V2R, and 5-HT4R. The patients and controls were enrolled in a test protocol consisting of stimulation by posture, mixed meal, ACTH, GnRH, TRH, glucagon, vasopressin, and metoclopramide (MCP). Three patients could be analyzed by both studies. A positive response was defined as an aldosterone increase of more than 50% following stimulation. RESULTS All the tissues revealed AT2R1, MC2R, AVPR, and 5-HT4R mRNA expression. LHR mRNA was found in normal adrenals and 13 adrenal tumors. By contrast with normal adrenals tumorous adrenal tissue expressed GnRHR mRNA (4/15) and TSHR mRNA (1/15). Both the patients and controls responded to posture, ACTH, glucagon, AVP, and MCP. Specific responses were seen in one patient following TRH and three patients following GnRH stimulation. CONCLUSIONS We provide evidence for peptide hormone responsiveness to various peptide hormones in patients with PA, including GnRH and TRH. A good correlation between clinical and molecular testing could be observed, making an involvement of the receptor expressed in PA possible.
Collapse
MESH Headings
- Adenoma/genetics
- Adrenal Gland Neoplasms/genetics
- Adult
- Aged
- Aldosterone/blood
- Genetic Testing
- Humans
- Hyperaldosteronism/genetics
- Middle Aged
- Receptor, Angiotensin, Type 1/genetics
- Receptor, Melanocortin, Type 2/genetics
- Receptors, G-Protein-Coupled/genetics
- Receptors, Gastrointestinal Hormone/genetics
- Receptors, Glucagon/genetics
- Receptors, LH/genetics
- Receptors, LHRH/genetics
- Receptors, Serotonin, 5-HT4/genetics
- Receptors, Thyrotropin/genetics
- Receptors, Thyrotropin-Releasing Hormone/genetics
- Receptors, Vasopressin/genetics
- Reverse Transcriptase Polymerase Chain Reaction
Collapse
Affiliation(s)
- O Zwermann
- Medizinische Klinik Innenstadt, Ludwig-Maximilian University, Munich, Germany
| | | | | | | | | |
Collapse
|
26
|
Tissier F. [What's new in bilateral adrenal cortex pathology?]. Ann Pathol 2008; 28 Spec No 1:S35-8. [PMID: 18984294 DOI: 10.1016/j.annpat.2008.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Frédérique Tissier
- Service d'anatomie pathologique, hôpital Cochin, AP-HP, 27, rue du faubourg Saint-Jacques, 75679 Paris cedex 14, France.
| |
Collapse
|
27
|
|
28
|
Exploration et prise en charge des incidentalomes surrénaliens. Consensus d’experts de la Société française d’endocrinologie. ANNALES D'ENDOCRINOLOGIE 2008. [DOI: 10.1016/j.ando.2008.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
29
|
Gordon RD. The case for high-dose dexamethasone suppression testing preoperatively in aldosterone-producing adenoma to exclude cosecretion of cortisol. Am J Hypertens 2008; 21:1176. [PMID: 18941449 DOI: 10.1038/ajh.2008.283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
30
|
Suzuki S, Uchida D, Koide H, Tanaka T, Noguchi Y, Saito Y, Tatsuno I. Hyper-responsiveness of adrenal gland to vasopressin resulting in enhanced plasma cortisol in patients with adrenal nodule(s). Peptides 2008; 29:1767-72. [PMID: 18620013 DOI: 10.1016/j.peptides.2008.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 06/16/2008] [Accepted: 06/16/2008] [Indexed: 11/21/2022]
Abstract
Hyper-responsiveness of plasma cortisol to vasopressin has been demonstrated in ACTH-independent bilateral macronodular adrenocortical hyperplasia (AIMAH) and some adrenal adenomas with Cushing's syndrome (CS). However, the clinical significance of hyper-responsiveness of plasma cortisol to vasopressin has not been investigated systematically in adrenal nodule(s). The aim of this study was to clarify the prevalence of hyper-responsiveness of plasma cortisol to vasopressin (vasopressin responder) and their clinical characteristics in terms of hormonal secretion using vasopressin-loading test in the patients with adrenal nodule(s) except pheochromocytomas. A vasopressin-loading test was performed on 61 consecutive patients with adrenal nodules (CS: 33, aldosterone-producing adenoma: 10, non-functional tumor: 18). Vasopressin responders were observed in 36.1% of adrenal nodule(s), 42.4% of CS and 28.5% of non-CS. In responders with CS, eight patients had bilateral nodules that were diagnosed as AIMAH, and the remaining six patients had a unilateral nodule. These patients had lower plasma cortisol than non-responders at both morning (P<0.01) and midnight (P<0.05), as well as the morning following overnight dexamethasone suppression at 1mg (P<0.05) and 8mg (P<0.05). Hyper-responsiveness of the adrenal gland to vasopressin resulting in enhanced plasma cortisol was frequently observed among patients with adrenal nodule(s). The vasopressin responders among the patients with adrenal nodule(s) frequently had CS with low autonomous cortisol secretion.
Collapse
Affiliation(s)
- Sawako Suzuki
- Department of Clinical Cell Biology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | | | | | | | | | | |
Collapse
|
31
|
Bernichtein S, Alevizaki M, Huhtaniemi I. Is the adrenal cortex a target for gonadotropins? Trends Endocrinol Metab 2008; 19:231-8. [PMID: 18691899 DOI: 10.1016/j.tem.2008.06.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Revised: 06/29/2008] [Accepted: 06/30/2008] [Indexed: 11/17/2022]
Abstract
The human adrenal cortex expresses low levels of luteinizing hormone/chorionic gonadotropin receptors (LHCGR), a characteristic gonad-specific G-protein coupled receptor (GPCR). LHCGR levels increase in the adrenal cortex after exposure to chronically elevated gonadotropins (e.g. after gonadectomy). In fact, heightened ectopic LHCGR levels are observed in a subclass of human adrenocortical tumors, and gonadotropin-responsive adrenocortical hyperplasia and tumors occur in several animal species. These findings suggest that adrenocortical responsiveness to LH/CG might be a physiological phenomenon that is amplified in the presence of elevated gonadotropin levels. Such increased gonadotropin action can induce pathologies ranging from adrenocorticotropic hormone (ACTH)-independent Cushing syndrome to malignant adrenal tumors. The authors review the current information on adrenocortical responses to gonadotropins in experimental animals and humans.
Collapse
Affiliation(s)
- Sophie Bernichtein
- Department of Reproductive Biology, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK
| | | | | |
Collapse
|
32
|
Galac S, Kars VJ, Voorhout G, Mol JA, Kooistra HS. ACTH-independent hyperadrenocorticism due to food-dependent hypercortisolemia in a dog: A case report. Vet J 2008; 177:141-3. [PMID: 17572120 DOI: 10.1016/j.tvjl.2007.04.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Revised: 03/30/2007] [Accepted: 04/04/2007] [Indexed: 11/22/2022]
Abstract
In addition to adrenocortical tumours, aberrant expression of functional hormone receptors in the adrenal cortex may cause adrenocorticotrophic hormone (ACTH)-independent hyperadrenocorticism. Here we report on a 6 year old Vizsla dog in which ACTH-independent hyperadrenocorticism was associated with meal-induced hypercortisolemia. Diagnosis was based on history, physical findings, biochemical changes, and elevation of the urinary corticoid/creatinine ratio (UCCR) on two consecutive days (11 and 8.3 x 10(-6), reference range <8.3 x 10(-6)). Basal plasma ACTH concentration was found by repeated measurements to be suppressed (<1 ng/L, reference range 5-85 ng/L) and administration of corticotrophin releasing hormone (CRH) resulted in a minor increase (to 6 ng/L), consistent with ACTH-independent hyperadrenocorticism. Ultrasonography and computed tomography revealed two uniformly enlarged adrenal glands. Magnetic resonance imaging of the pituitary area showed a non-enlarged, normally enhancing pituitary gland. Based on these results, expression of functional aberrant adrenocortical receptors was suspected and the possibility of food-dependent hyperadrenocorticism was explored. The UCCR on two separate occasions rose from 11 and 8 x 10(-6) before a meal to 25 and 23 x 10(-6) at 3 h after ingestion of a meal, respectively. There was a corresponding increase in plasma cortisol concentration (from 90 to 150 nmol/L), while plasma ACTH concentration remained low or undetectable. Consistent with the diagnostic criteria for food-dependent hyperadrenocorticism in humans, administration of octreotide completely prevented meal-induced hypercortisolemia. The dog was treated successfully with the cortisol-synthesis-inhibitor trilostane (2h before meal), and at 26 months after the final diagnosis the dog is still in good condition. The combination of (1) low plasma ACTH concentration in the absence of an adrenocortical tumour, (2) an increase of >100% in UCCR after ingestion of a meal, (3) prevention of the meal-induced increase in plasma cortisol concentration by octreotide, and (4) reversal of signs of hypercortisolism by administration of trilostane a few hours before the meal led to the diagnosis of food-dependent hyperadrenocorticism in this dog.
Collapse
Affiliation(s)
- S Galac
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 8, P.O. Box 80.154, 3508 TD Utrecht, The Netherlands.
| | | | | | | | | |
Collapse
|
33
|
Zeugswetter F, Hoyer MT, Pagitz M, Benesch T, Hittmair KM, Thalhammer JG. The desmopressin stimulation test in dogs with Cushing's syndrome. Domest Anim Endocrinol 2008; 34:254-60. [PMID: 17851017 DOI: 10.1016/j.domaniend.2007.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Revised: 07/23/2007] [Accepted: 07/24/2007] [Indexed: 11/22/2022]
Abstract
Desmopressin is a synthetic analogue of the hypothalamic peptide vasopressin and binds to specific pituitary vasopressin (V3) receptors. The V3-receptor is overexpressed in pituitary corticotrope tumors and the injection of desmopressin induces a marked ACTH and cortisol release in human patients with pituitary- (PDH), but not adrenal tumor (AT) dependent hyperadrenocorticism. In this prospective study, we investigated the effects of desmopressin on serum cortisol levels in 80 dogs suspected of Cushing's syndrome. The aim was to find a sensitive and specific test to exclude AT. According to standard tests the dogs were divided into 3 groups (group 1=other disease, n=27; group 2=PDH, n=46; group 3=AT, n=7). Desmopressin was injected as an i.v. bolus of 4microg and serial blood samples were collected before and after 30, 60 and 90min. Desmopressin significantly stimulated cortisol release in dogs with PDH (median 51%, range -24 to 563%; p<0.0001), whereas no increase was seen in dogs with AT (median -12%, range -44 to 5%; p=0.063) and in controls (median +7%, range -36 to 196%; p=0.131). Using a cut off value of 10% increase over baseline, it was possible to exclude AT in 75% of patients. The results of this study suggest that the desmopressin test could be a useful tool in differentiating pituitary from adrenal dependent Cushing's syndromes. Additional dogs with adrenocortical tumor must be tested in order to recommend its use in clinical practice.
Collapse
Affiliation(s)
- F Zeugswetter
- Clinical Department of Small Animals and Horses, University of Veterinary Medicine Vienna, Veterinaerplatz 1, 1210 Vienna, Austria.
| | | | | | | | | | | |
Collapse
|
34
|
Sijmons RH. Encyclopaedia of tumour-associated familial disorders. Part I: from AIMAH to CHIME syndrome. Hered Cancer Clin Pract 2008; 6:22-57. [PMID: 19706204 PMCID: PMC2735164 DOI: 10.1186/1897-4287-6-1-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Accepted: 02/12/2008] [Indexed: 11/10/2022] Open
Abstract
Cancer is associated with a wide range of hereditary disorders. Recognizing these disorders in cancer patients may be of great importance for the medical management of both patients and their relatives. Conversely, recognizing the fact that cancer may develop as a complication of a particular hereditary disorder which has already been diagnosed may be important for the same reason. The Familial Cancer Database (FaCD) is a web-based application http://www.facd.info which has been developed at our department with the intention to assist clinicians and genetic counsellors in making a genetic differential diagnosis in cancer patients, as well as in becoming aware of the tumour spectrum associated with hereditary disorders that have already been diagnosed in their patients. This encyclopaedia is published in parts and discusses the disorders included in the FaCD database in alphabetical order. It lists names, synonyms, OMIM number, mode of inheritance, associated genes, phenotype, clinical discussion and references. The purpose of presenting this encyclopaedia in paper format is simply that we hope that you as clinicians and researchers find it helpful to browse through it and familiarize yourself even better with the scope of genetic disorders that have been associated with increased tumour risk.
Collapse
Affiliation(s)
- Rolf H Sijmons
- Department of Genetics, University Medical Center, University of Groningen, Groningen, The Netherlands.
| |
Collapse
|
35
|
Bernichtein S, Petretto E, Jamieson S, Goel A, Aitman TJ, Mangion JM, Huhtaniemi IT. Adrenal gland tumorigenesis after gonadectomy in mice is a complex genetic trait driven by epistatic loci. Endocrinology 2008; 149:651-61. [PMID: 18006632 PMCID: PMC2556873 DOI: 10.1210/en.2007-0925] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Postgonadectomy adrenocortical tumorigenesis is a strain-specific phenomenon in inbred mice, assumed to be caused by elevated LH secretion and subsequent ectopic LH receptor (LHR) overexpression in adrenal gland. However, the molecular mechanisms of this cascade of events remain unknown. In this study, we took advantage of the mouse strain dependency of the phenotype to unravel its genetic basis. Our results present the first genome-wide screening related to this pathology in two independent F2 and backcross populations generated between the neoplastic DBA/2J and the nonsusceptible C57BL/6J strains. Surprisingly, the postgonadectomy elevation of serum LH was followed by similar up-regulation of adrenal LHR expression in both parental strains and their crosses, irrespective of their tumor status, indicating that it is not the immediate cause of the tumorigenesis. Linkage analysis revealed one major significant locus for the tumorigenesis on chromosome 8, modulated by epistasis with another quantitative trait locus on chromosome 18. Weight gain, a secondary phenotype after gonadectomy, showed a significant but separate quantitative trait locus on chromosome 7. Altogether, postgonadectomy adrenocortical tumorigenesis in DBA/2J mice is a dominant trait that is not a direct consequence of adrenal LHR expression but is driven by a complex genetic architecture. Analysis of candidate genes in the tumorigenesis linkage region showed that Sfrp1 (secreted frizzled-related protein 1), a tumor suppressor gene, is differentially expressed in the neoplastic areas. These findings may have relevance to the human pathogenesis of macronodular adrenal hyperplasia and adrenocortical tumors in postmenopausal women and why some of them develop obesity.
Collapse
Affiliation(s)
- Sophie Bernichtein
- Department of Reproductive Biology, Physiological Genomics and Medicine Group, Medical Research Council, Clinical Sciences Center, Faculty of Medicine, Imperial College London, London, UK
| | | | | | | | | | | | | |
Collapse
|
36
|
Vasopressin-Responsive ACTH-Independent Macronodular Adrenal Hyperplasia Causing Cushing's Syndrome. Tzu Chi Med J 2007. [DOI: 10.1016/s1016-3190(10)60010-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
37
|
Bourdeau I, Lampron A, Costa MHS, Tadjine M, Lacroix A. Adrenocorticotropic hormone-independent Cushing's syndrome. Curr Opin Endocrinol Diabetes Obes 2007; 14:219-25. [PMID: 17940443 DOI: 10.1097/med.0b013e32814db842] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW Endogenous Cushing's syndrome is adrenocorticotropic hormone (or corticotropin)-independent in 15-20% of cases. Primary Cushing's syndrome is most often secondary to adrenocortical adenomas or carcinomas, and more rarely to bilateral adrenal hyperplasias. Corticotropin-independent cortisol-producing hyperplasia is caused by micronodular diseases, including primary pigmented nodular adrenocortical disease and nonpigmented micronodular hyperplasia and adrenocorticotropic hormone-independent macronodular adrenal hyperplasia. Primary pigmented nodular adrenocortical disease can be found either alone or in the context of Carney complex, a multiple endocrine neoplasia syndrome. RECENT FINDINGS In recent years, the pathophysiology of adrenocortical tumors and hyperplasias became better understood following the identification of genes responsible for syndromes associated with corticotropin-independent Cushing's syndrome and the demonstration of aberrant expression and function of various hormone receptors in adrenocortical adenomas and adrenocorticotropic hormone-independent macronodular adrenal hyperplasia. This article reviews findings on the molecular and genetic aspects of corticotropin-independent Cushing's syndrome including recent gene expression profiling studies of adrenocortical tumors and hyperplasias and animal models that provided clues on the pathogenesis of primary Cushing's syndrome. SUMMARY A better understanding of molecular mechanisms involved in adrenocortical tumors and hyperplasias may lead to improved diagnostic and prognostic markers and treatment strategies to assist clinicians in the management of corticotropin-independent Cushing's syndrome.
Collapse
Affiliation(s)
- Isabelle Bourdeau
- Division of Endocrinology, Department of Medicine and Research Center, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
| | | | | | | | | |
Collapse
|