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Zhou Z, Chai W, Yang L, Liu Y, Liu Y, Pan H, Wu Q, Zhang X, Roessner ED. Successful resolution of ectopic Cushing syndrome by minimally invasive thoracoscopic resection of the neuroendocrine tumor of the thymus: a rare case report. BMC Surg 2022; 22:226. [PMID: 35690804 PMCID: PMC9188062 DOI: 10.1186/s12893-022-01674-0] [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: 12/06/2021] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Ectopic Cushing syndrome (ECS) is a sporadic condition. Even uncommon is an ECS that derives from a carcinoid tumor of the thymus. These tumors may pose several diagnostic and therapeutic conundrums. This report discusses the differential diagnosis, clinicopathological findings, and effective treatment of a rare case of ECS using a minimally invasive approach. Case presentation A 29-year-old woman with Cushing syndrome presented with facial flushing. Physical examination revealed hypertension (blood pressure: 141/100 mmHg). A mediastinal tumor was discovered to be the cause of the patient’s chronic hypokalemia and hypercortisolemia. Cortisol levels increased in the morning, reaching 47.7 ug/dL. The levels of the hormones ACTH, aldosterone, and renin were determined to be 281 pg/mL, 3.0 ng/dL, and 2.1 pg/mL, respectively. The presence of hypertension, hypokalemia, and alkalinity suggested Cushing’s syndrome, which was proven to be ACTH-dependent ECS by a dexamethasone suppression test. A chest CT scan revealed inflammation in the posterior basal region of the right lower lobe. The superior anterior mediastinum was characterized by round-shaped isodensity lesions with distinct borders. She underwent thoracoscopic anterior mediastinal tumor excision via the subxiphoid technique (R0 resection); following surgery, her blood pressure returned to normal, and the hypernatremia/hypopotassemia resolved. The tumor was determined to be a thymic carcinoid. Most notably, cortisol levels fell to half of their presurgical levels after one hour of surgery, and other abnormalities corrected substantially postoperatively. Conclusion Thoracoscopic excision of thymic tumors by subxiphoid incision may be a useful treatment option for ECS caused by neuroendocrine tumors of the thymus
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Affiliation(s)
- Zizi Zhou
- Department of Cardio-Thoracic Surgery, Shenzhen University General Hospital, Xueyuan Avenue 1098, Nanshan District, 518055, Shenzhen, China
| | - Wenxiang Chai
- Department of Cardio-Thoracic Surgery, Shenzhen University General Hospital, Xueyuan Avenue 1098, Nanshan District, 518055, Shenzhen, China
| | - Longhai Yang
- Department of Cardio-Thoracic Surgery, Shenzhen University General Hospital, Xueyuan Avenue 1098, Nanshan District, 518055, Shenzhen, China
| | - Yi Liu
- Department of Cardio-Thoracic Surgery, Shenzhen University General Hospital, Xueyuan Avenue 1098, Nanshan District, 518055, Shenzhen, China
| | - Yao Liu
- Department of Cardio-Thoracic Surgery, Shenzhen University General Hospital, Xueyuan Avenue 1098, Nanshan District, 518055, Shenzhen, China
| | - Huiyu Pan
- Department of Cardio-Thoracic Surgery, Shenzhen University General Hospital, Xueyuan Avenue 1098, Nanshan District, 518055, Shenzhen, China
| | - Qiang Wu
- Department of Cardio-Thoracic Surgery, Shenzhen University General Hospital, Xueyuan Avenue 1098, Nanshan District, 518055, Shenzhen, China
| | - Xiaoming Zhang
- Department of Cardio-Thoracic Surgery, Shenzhen University General Hospital, Xueyuan Avenue 1098, Nanshan District, 518055, Shenzhen, China.
| | - Eric Dominic Roessner
- Department of Thoracic Surgery, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
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Gosavi V, Lila A, Memon SS, Sarathi V, Thakkar K, Dalvi A, Malhotra G, Prakash G, Patil V, Shah NS, Bandgar T. Clinical Spectrum of Adrenal Cushing's Syndrome and the Caution for Interpretation of Adrenocorticotrophic Hormone: A Single-Center Experience. Horm Metab Res 2022; 54:57-66. [PMID: 35130566 DOI: 10.1055/a-1735-3232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
UNLABELLED To describe the differences in presentation, biochemistry, and radiological evaluation of various etiologies of adrenal Cushing's syndrome (CS) from a single center. To emphasize caution for interpretation of plasma adrenocorticotropic hormone (ACTH), as a spuriously unsuppressed ACTH level by immunometric assay may lead to therapeutic misadventures in adrenal CS. DESIGN Retrospective, single-center, observational study. METHODS Fifty-eight adrenal CS patients [Adrenocortical carcinoma (ACC), n=30; Adenoma (ACA), n=15; Primary pigmented nodular adrenocortical disease (PPNAD), n=10; ACTH independent macronodular adrenal hyperplasia (AIMAH), n=3) evaluated at a tertiary care center in western India between January 2006 to March 2020 were included. Data on demography, clinical evaluation, biochemistry, imaging, management, histopathology, and outcome were recorded in a standard format and analyzed. RESULTS Cortisol secreting ACC presented at 38(1-50) years with abdominal mass in 26/30 (86.7%) and 16/30 (53.3%) had metastases at presentation. ACA with autonomous cortisol excess presented at 25(4.9-40) years with discriminating features of CS in 14/15 (93.3%), sex steroid production in 2/15, unenhanced HU <10 in only one, and relative washout >40% in 8/11 (72.7%). One ACA and eight ACC patients had plasma ACTH (by Siemens Immulite assay) > 20 pg/ml, despite hypercortisolemic state. CONCLUSIONS Cortisol-secreting ACC and ACA most often present with mass effects and florid CS, respectively. Baseline HU has low sensitivity to differentiate cortisol-secreting ACA from ACC. Plasma ACTH measured by Seimens Immulite is often unsuppressed, especially in ACC patients, which can be addressed by measuring ACTH by more accurate assays.
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Affiliation(s)
- Vikrant Gosavi
- Department of Endocrinology, Seth G. S. Medical College and KEM Hospital, Mumbai, India
| | - Anurag Lila
- Department of Endocrinology, Seth G. S. Medical College and KEM Hospital, Mumbai, India
| | - Saba Samad Memon
- Department of Endocrinology, Seth G. S. Medical College and KEM Hospital, Mumbai, India
| | - Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Kunal Thakkar
- Sterling Ramkrishna Speciality Hospital, Gandhidham, India
| | - Abhay Dalvi
- Department of Surgery, Seth G. S. Medical College and KEM Hospital, Mumbai, India
| | - Gaurav Malhotra
- Department of Nuclear Medicine, Bhabha Atomic Research Centre, Mumbai, India
| | - Gagan Prakash
- Department of Uro-oncology, Tata Memorial Hospital, Mumbai, India
| | - Virendra Patil
- Department of Endocrinology, Seth G. S. Medical College and KEM Hospital, Mumbai, India
| | - Nalini S Shah
- Department of Endocrinology, Seth G. S. Medical College and KEM Hospital, Mumbai, India
| | - Tushar Bandgar
- Department of Endocrinology, Seth G. S. Medical College and KEM Hospital, Mumbai, India
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Mallari RJ, Thakur JD, Barkhoudarian G, Eisenberg A, Rodriguez A, Rettinger S, Cohan P, Nieman L, Kelly DF. Diagnostic Pitfalls in Cushing Disease: Surgical Remission Rates, Test Thresholds, and Lessons Learned in 105 Patients. J Clin Endocrinol Metab 2022; 107:205-218. [PMID: 34478542 PMCID: PMC8684536 DOI: 10.1210/clinem/dgab659] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Confirming a diagnosis of Cushing disease (CD) remains challenging, yet is critically important before recommending transsphenoidal surgery for adenoma resection. OBJECTIVE To describe predictive performance of preoperative biochemical and imaging data relative to post-operative remission and clinical characteristics in patients with presumed CD. DESIGN, SETTING, PATIENTS, INTERVENTIONS Patients (n = 105; 86% female) who underwent surgery from 2007 through 2020 were classified into 3 groups: group A (n = 84) pathology-proven ACTH adenoma; group B (n = 6) pathology-unproven but with postoperative hypocortisolemia consistent with CD; and group C (n = 15) pathology-unproven, without postoperative hypocortisolemia. Group A + B were combined as confirmed CD and group C as unconfirmed CD. MAIN OUTCOMES Group A + B was compared with group C regarding predictive performance of preoperative 24-hour urinary free cortisol (UFC), late night salivary cortisol (LNSC), 1-mg dexamethasone suppression test (DST), plasma ACTH, and pituitary magnetic resonance imaging (MRI). RESULTS All groups had a similar clinical phenotype. Compared with group C, group A + B had higher mean UFC (P < 0.001), LNSC (P = 0.003), DST (P = 0.06), and ACTH (P = 0.03) and larger MRI-defined lesions (P < 0.001). The highest accuracy thresholds were: UFC 72 µg/24 hours; LNSC 0.122 µg/dL, DST 2.70 µg/dL, and ACTH 39.1 pg/mL. Early (3-month) biochemical remission was achieved in 76/105 (72%) patients: 76/90(84%) and 0/15(0%) of group A + B vs group C, respectively, P < 0.0001. In group A + B, nonremission was strongly associated with adenoma cavernous sinus invasion. CONCLUSIONS Use of strict biochemical thresholds may help avoid offering transsphenoidal surgery to presumed CD patients with equivocal data and improve surgical remission rates. Patients with Cushingoid phenotype but equivocal biochemical data warrant additional rigorous testing.
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Affiliation(s)
- Regin Jay Mallari
- Pacific Pituitary Disorders Center, Pacific Neuroscience Institute, Santa Monica, CA 90404, USA
| | - Jai Deep Thakur
- Pacific Pituitary Disorders Center, Pacific Neuroscience Institute, Santa Monica, CA 90404, USA
- University of South Alabama, Mobile, AL 36604, USA
| | - Garni Barkhoudarian
- Pacific Pituitary Disorders Center, Pacific Neuroscience Institute, Santa Monica, CA 90404, USA
- Saint John’s Cancer Institute at Saint John’s Health Center, Santa Monica, CA 90404, USA
| | - Amy Eisenberg
- Pacific Pituitary Disorders Center, Pacific Neuroscience Institute, Santa Monica, CA 90404, USA
| | - Amanda Rodriguez
- Pacific Pituitary Disorders Center, Pacific Neuroscience Institute, Santa Monica, CA 90404, USA
| | - Sarah Rettinger
- Pacific Pituitary Disorders Center, Pacific Neuroscience Institute, Santa Monica, CA 90404, USA
| | - Pejman Cohan
- Pacific Pituitary Disorders Center, Pacific Neuroscience Institute, Santa Monica, CA 90404, USA
| | - Lynnette Nieman
- Diabetes, Endocrine and Obesity Branch, The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD 20814, USA
| | - Daniel F Kelly
- Pacific Pituitary Disorders Center, Pacific Neuroscience Institute, Santa Monica, CA 90404, USA
- Saint John’s Cancer Institute at Saint John’s Health Center, Santa Monica, CA 90404, USA
- Correspondence: Daniel F. Kelly, MD, Pacific Neuroscience Institute, Saint John’s Cancer Institute, Providence Saint John’s Health Center, 2125 Arizona Ave., Santa Monica, CA 90404, USA.
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Cateterismo de senos petrosos inferiores y estimulación con CRH: 15 años de experiencia en un hospital de tercer nivel. ENDOCRINOL DIAB NUTR 2021. [DOI: 10.1016/j.endinu.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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González Fernández L, Añez Ramos RJ, Rivas Montenegro AM, Brox Torrecilla N, Miguélez González M, Muñoz Moreno D, Atencia Goñi J, Weber B, López Guerra A, Olmedilla Ishishi YL, Percovich Hualpa JC, González Albarrán O, García Centeno R. Inferior petrosal sinus sampling and stimulation with CRH: 15 years of experience in a tertiary hospital. ENDOCRINOL DIAB NUTR 2021; 68:381-388. [PMID: 34742471 DOI: 10.1016/j.endien.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/03/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Inferior petrosal sinus sampling (IPSS) is indicated in the diagnosis of adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome (CS), especially when the results of the initial diagnostic tests are discordant. OBJECTIVE To describe the patients who underwent this invasive functional test in a tertiary hospital. METHODS This was an observational study of a retrospective cohort of patients with ACTH-dependent CS and IPSS between 2004 and 2019. We determined their epidemiological, hormonal, radiological and functional characteristics, and evaluated their diagnostic capacity and optimal cut-off points to differentiate between Cushing's disease (CD) and ectopic Cushing's syndrome (ECS). RESULTS 23 patients were evaluated, of which 65.2% were women with the average age of 42 (36-62) years. ACTH secretion of pituitary origin was evident in 82.6% of the patients and of ectopic origin in 17.4%. Plasma cortisol, urinary free cortisol, and ACTH levels were higher in patients with ECS. Regarding IPSS, the baseline central/peripheral ACTH gradient detected 89.5% of patients with CD and after stimulation with CRH, 100%. The optimal cut-off points in the diagnosis of CD were 2.06 at baseline and 2.49 after CRH stimulation. CONCLUSION IPSS with CRH stimulation is a test with a high diagnostic accuracy for correctly classifying patients with CD and ECS. The cut-off points of the gradients may be different from the classic ones. Therefore, we recommend that each center perform its own evaluation.
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Affiliation(s)
- Laura González Fernández
- Servicio de Endocrinología y Nutrición, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Roberto José Añez Ramos
- Servicio de Endocrinología y Nutrición, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Noemí Brox Torrecilla
- Servicio de Endocrinología y Nutrición, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Miguélez González
- Servicio de Endocrinología y Nutrición, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Diego Muñoz Moreno
- Servicio de Endocrinología y Nutrición, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Atencia Goñi
- Servicio de Endocrinología y Nutrición, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Bettina Weber
- Servicio de Endocrinología y Nutrición, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Aurelio López Guerra
- Servicio de Endocrinología y Nutrición, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Olga González Albarrán
- Servicio de Endocrinología y Nutrición, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rogelio García Centeno
- Servicio de Endocrinología y Nutrición, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Chen K, Chen S, Lu L, Zhu H, Zhang X, Tong A, Pan H, Wang R, Lu Z. An Optimized Pathway for the Differential Diagnosis of ACTH-Dependent Cushing's Syndrome Based on Low-Dose Dexamethasone Suppression Test. Front Endocrinol (Lausanne) 2021; 12:720823. [PMID: 34539574 PMCID: PMC8445331 DOI: 10.3389/fendo.2021.720823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/10/2021] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Traditionally, low-dose dexamethasone suppression test (LDDST) was used to confirm the diagnosis of Cushing's syndrome (CS), and high-dose dexamethasone suppression test (HDDST) was used to differentiate Cushing's disease (CD) and ectopic adrenocorticotropin (ACTH) syndrome (EAS), but some studies suggested that HDDST might be replaced by LDDST. For the differential diagnosis of CS, dexamethasone suppression test was usually combined with other tests such as bilateral petrosal sinus sampling (BIPSS) and pituitary magnetic resonance imaging, but the optimal pathway to incorporate these tests is still controversial. OBJECTIVES To develop an optimized pathway for the differential diagnosis of CD and EAS based on LDDST. DESIGN AND SETTING Single-center retrospective study (2011-2019). PATIENTS Two hundred sixty-nine CD and 29 EAS patients with pathological diagnosis who underwent consecutive low- and high-dose DST. RESULTS For the differential diagnosis of CD and EAS, the area under curve (AUC) of LDDST using urine free cortisol (0.881) was higher than that using serum cortisol (0.685) (p < 0.001) in head-to-head comparison among a subgroup of 108 CD and 10 EAS. The AUC of LDDST (0.883) was higher than that of HDDST (0.834) among all the included patients. With the cutoff of <26%, the sensitivity and specificity of LDDST were 39.4% and 100%. We designed a new pathway in which BIPSS was only reserved for those patients with unsuppressed LDDST and adenoma <6mm, yielding an overall sensitivity of 97.7% and specificity of 86.7%. CONCLUSION LDDST had similar value to HDDST in differentiating CD and EAS using the specific cutoff point. The pathway that combined LDDST and BIPSS could differentiate CD and EAS accurately.
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Affiliation(s)
- Kang Chen
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Eight-Year Program of Clinical Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shi Chen
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Shi Chen, ; Lin Lu,
| | - Lin Lu
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Shi Chen, ; Lin Lu,
| | - Huijuan Zhu
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaobo Zhang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Anli Tong
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hui Pan
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhaolin Lu
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Jensterle M, Lezaic L, Jeruc J, Janez A. Periprostatic paraganglioma causing occult Cushing's syndrome. Endocrine 2020; 69:461-463. [PMID: 32372304 DOI: 10.1007/s12020-020-02335-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Mojca Jensterle
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
- Department of Endocrinology, Diabetes and Metabolic Disease, University Medical Center Ljubljana, Ljubljana, Slovenia.
| | - Luka Lezaic
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department for Nuclear Medicine, University Medical Centre, Ljubljana, Slovenia
| | - Jera Jeruc
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andrej Janez
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Endocrinology, Diabetes and Metabolic Disease, University Medical Center Ljubljana, Ljubljana, Slovenia
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Pallais JC, Fenves AZ, Lu MT, Glomski K. Case 18-2018: A 45-Year-Old Woman with Hypertension, Fatigue, and Altered Mental Status. N Engl J Med 2018; 378:2322-2333. [PMID: 29897853 DOI: 10.1056/nejmcpc1802825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- J Carl Pallais
- From the Department of Medicine, Brigham and Women's Hospital (J.C.P.), the Departments of Medicine (A.Z.F.), Radiology (M.T.L.), and Pathology (K.G.), Massachusetts General Hospital, and the Departments of Medicine (J.C.P., A.Z.F.), Radiology (M.T.L.), and Pathology (K.G.), Harvard Medical School - all in Boston
| | - Andrew Z Fenves
- From the Department of Medicine, Brigham and Women's Hospital (J.C.P.), the Departments of Medicine (A.Z.F.), Radiology (M.T.L.), and Pathology (K.G.), Massachusetts General Hospital, and the Departments of Medicine (J.C.P., A.Z.F.), Radiology (M.T.L.), and Pathology (K.G.), Harvard Medical School - all in Boston
| | - Michael T Lu
- From the Department of Medicine, Brigham and Women's Hospital (J.C.P.), the Departments of Medicine (A.Z.F.), Radiology (M.T.L.), and Pathology (K.G.), Massachusetts General Hospital, and the Departments of Medicine (J.C.P., A.Z.F.), Radiology (M.T.L.), and Pathology (K.G.), Harvard Medical School - all in Boston
| | - Krzysztof Glomski
- From the Department of Medicine, Brigham and Women's Hospital (J.C.P.), the Departments of Medicine (A.Z.F.), Radiology (M.T.L.), and Pathology (K.G.), Massachusetts General Hospital, and the Departments of Medicine (J.C.P., A.Z.F.), Radiology (M.T.L.), and Pathology (K.G.), Harvard Medical School - all in Boston
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Reza-Albarrán AA, Andino Ríos GG, Gómez Herrera LG. Etomidate in the control of severe Cushing's syndrome by neuroendocrine carcinoma. Clin Case Rep 2018; 6:851-854. [PMID: 29744071 PMCID: PMC5930188 DOI: 10.1002/ccr3.1478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/01/2018] [Accepted: 02/14/2018] [Indexed: 11/26/2022] Open
Abstract
Etomidate is a very effective drug in severe Cushing's syndrome that is refractory to ketoconazol. Control of the serum cortisol levels in ectopic Cushing's syndrome can be obtained with infusion rates much lower than those used in anesthesia, without respiratory side effects.
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Affiliation(s)
- Alfredo Adolfo Reza-Albarrán
- Department of Endocrinology and Metabolism Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Vasco de Quiroga 15 Tlalpan, México City 14000 México
| | - Gerson Geovany Andino Ríos
- Department of Endocrinology and Metabolism Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Vasco de Quiroga 15 Tlalpan, México City 14000 México
| | - Laura Gabriela Gómez Herrera
- Department of Endocrinology and Metabolism Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Vasco de Quiroga 15 Tlalpan, México City 14000 México
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