Cyclic Cushing’s syndrome: a case study and overview

Česká verzia

Authors: Jana Kollerová ¹; Ján Malina ²; Andrej Šteňo ³; Pavol Povinec ⁴; Juraj Payer ¹
Authors place of work: V. interná klinika LF UK a UNB, Nemocnica Ružinov, Bratislava, Slovenská republika ¹; Klinika onkologickej chirurgie LF UK a Onkologický ústav sv. Alžbety, Bratislava, Slovenská republika ²; Neurochirurgická klinika LF UK a UNB, Nemocnica Akademika L. Dérera, Bratislava, Slovenská republika ³; Pracovisko BIONT, a. s., Bratislava, Slovenská republika ⁴
Published in the journal: Vnitř Lék 2018; 64(4): 450-456
Category: Case Reports

Práca bola prvýkrát prednesená na XXXIX. endokrinologických dňoch s medzinárodnou účasťou (29. 9.–1. 10. 2016, Košice, Slovenská republika

Summary

Cushing’s syndrome and especially Cushing´s disease represent diagnostically and therapeutically complicated medical situations. In some patients, cyclic changes in cortisol production additionally hamper the diagnosis in terms of source identification and management of hormone overproduction. It may not be clear, whether the patient is cured or not even years after the treatment. It is a rare disorder variant, but we assume that it is underdiagnosed and it´s incidence is actually higher. The article deals with a complicated course of diagnosis and treatment in a patient with cyclic Cushing’s syndrome.

Key words:
Cushing´s disease – cyclic Cushing´s syndrome – hypercortisolism

Zdroje

1. Boscaro M, Barzon L, Fallo F et al. Cushing’s syndrome. Lancet 2001; 357(9258): 783–791. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(00)04172–6>.

2. Meinardi JR, Wolffenbuttel BHR, Dullaart RP. Cyclic Cushing’s syndrome: a clinical challenge. Eur J Endocrinol 2007; 157(3): 245–254. Dostupné z DOI: <http://dx.doi.org/10.1530/EJE-07–0262>.

3. Alexandraki KI, Kaltsas GA, Isidori AM et al. The prevalence and characteristic features of cyclicity and variability in Cushing’s disease. Eur J Endocrinol 2009; 160(6): 1011–1018. Dostupné z DOI: <http://dx.doi.org/10.1530/EJE-09–0046>.

4. Kršek M, Čáp J, Hána V et al. Doporučení České endokrinologické společnosti pro léčbu Cushingova syndromu v dospělosti. Vnitř Lék 2013; 59(9): 819–827.

5. Brown RD, Van Loon GR, Orth DN et al. Cushing’s disease with periodic hormonogenesis: one explanation for paradoxical response to dexamethasone. J Clin Endocrinol Metab 1973; 36(3): 445–451. Dostupné z DOI: <http://dx.doi.org/10.1210/jcem-36–3-445>.

6. Bailey RE. Periodic hormonogenesis – a new phenomenon. Periodicity in function of a hormone-producing tumor in man. J Clin Endocrinol Metab 1971; 32(3): 317–327. Dostupné z DOI: <http://dx.doi.org/10.1210/jcem-32–3-317>.

7. Bassoe HH, Emberland R, Stoa KF. Fluctuating steroid excretion in Cushing’s syndrome. Acta Endocrinol (Copenh) 1958; 28(2): 163–168.

8. Orth DN. Cushing’s syndrome. N Engl J Med 1995; 332(12): 791–803. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJM199503233321207>.Erratum in N Engl J Med 1995; 332(22): 1527.

9. Petersenn S, Newell-Price J, Findling JW et al. High variability in baseline urinary free cortisol values in patients with Cushing’s disease. Clin Endocrinol (Oxf) 2014; 80(2): 261–269. Dostupné z DOI: <http://dx.doi.org/10.1111/cen.12259>.

10. Atkinson B, Mullan KR. What is the best approach to suspected cyclical Cushing syndrome? Strategies for managing Cushing’s syndrome with variable laboratory data. Clin Endocrinol (Oxf) 2011; 75(1): 27–30. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1365–2265.2011.04033.x>.