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Iacopo Chiodini - One of the best experts on this subject based on the ideXlab platform.
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Adrenal Hypercortisolism: A Closer Look at Screening, Diagnosis, and Important Considerations of Different Testing Modalities.
Journal of the Endocrine Society, 2019Co-Authors: Iacopo Chiodini, Arelys Ramos-rivera, Alan O Marcus, Hanford YauAbstract:Although prolonged Hypercortisolism is associated with increased mortality and substantial morbidity, the clinical signs and symptoms are wide ranging and often nonspecific, contributing to challenges in diagnosis, as well as treatment delays. Greater awareness is needed among clinicians to help identify which patients should undergo biochemical screening for excess cortisol. Several biochemical tests are available, each with important caveats that should be considered in the context of the individual patient. Cortisol secretion varies widely, further complicating the biochemical diagnosis of Hypercortisolism, which relies on the use of definitive cutoff values. Patients with Hypercortisolism resulting from adrenal adenomas, including those discovered incidentally, often do not present with overt Cushingoid features (plethora, striae, muscle weakness, moon facies, etc.). However, the consequences of prolonged exposure to even slight elevations in cortisol levels are profound, including increased risk of diabetes, hypertension, fractures, cardiovascular events, and mortality. Because most cases of Hypercortisolism resulting from an adrenal adenoma can be managed, it is imperative to identify patients at risk and initiate testing early for the best outcomes. The aim of this report is to increase awareness of the indications for screening for Hypercortisolism and to review the biochemical screening tests and diagnosis for Hypercortisolism associated with adrenal adenomas.
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Screening for ACTH-dependent Hypercortisolism in patients affected with pituitary incidentaloma
European journal of endocrinology, 2015Co-Authors: A Toini, Alessia Dolci, Emanuele Ferrante, Elisa Verrua, Elena Malchiodi, Elisa Sala, Andrea Lania, Iacopo Chiodini, Paolo Beck-peccoz, Maura ArosioAbstract:Context: Pituitary incidentalomas (PIs) are commonly encountered in clinical practice. The management of these asymptomatic pituitary lesions is still controversial. Systematic screening for subclinical or mild ACTH-dependent Hypercortisolism (AH) is not presently recommended, due to the limited data available thus far on the epidemiological and clinical relevance of this condition in patients with PIs. As subclinical Hypercortisolism (SH) was considered to be associated with chronic complications of overt cortisol excess, such as hypertension, diabetes, and osteoporosis, this disorder should be diagnosed at the early stage. Objective: The objective of this study was to evaluate the prevalence of Hypercortisolism in a population of subjects with PIs. Design, subjects, and methods: A total of 68 consecutive patients (48 females and 20 males, aged 18-82 years) without clinically overt Hypercortisolism, who were referred for evaluation of PIs between January 2010 and March 2013, were prospectively investigated for AH. Pituitary Hypercortisolism was diagnosed in the presence of cortisol O50 nmol/l after 1 mg dexamethasone suppression test, non-suppressed ACTH, and the additional finding of one of the following: urinary free cortisol (UFC) O193 nmol/24 h, and midnight serum and salivary cortisol levels O207 and 2.8 nmol/l respectively. Results: Among patients with PIs, we found a 7.3% rate of pituitary Hypercortisolism diagnosed with biochemical criteria and a 4.4% rate of histologically confirmed AH. Conclusions: Subclinical or mild Hypercortisolism may be more common than generally perceived in patients with PIs.
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GH secretion reserve in subclinical Hypercortisolism
Pituitary, 2013Co-Authors: Serena Palmieri, Paolo Beck-peccoz, Alfredo Scillitani, Valentina Morelli, Antonio Stefano Salcuni, Cristina Eller-vainicher, Elisa Cairoli, Volha V. Zhukouskaya, Iacopo ChiodiniAbstract:Purpose In overt Hypercortisolism, growth hormone (GH) secretion is decreased and normalizes after surgery. In subclinical Hypercortisolism (SH), GH secretion has been scarcely investigated. We assessed GH reserve in patients with and without SH and, in the former, also after recovery.
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Diagnosis and Treatment of Subclinical Hypercortisolism
The Journal of clinical endocrinology and metabolism, 2011Co-Authors: Iacopo ChiodiniAbstract:Subclinical Hypercortisolism might be more frequent than expected in populations at risk, but the diagnostic criteria are debated; the recovery might improve the metabolic consequences.
Lynnette K Nieman - One of the best experts on this subject based on the ideXlab platform.
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Diagnosis of Cushing's Syndrome in the Modern Era.
Endocrinology and metabolism clinics of North America, 2018Co-Authors: Lynnette K NiemanAbstract:Four challenges complicate the evaluation for Cushing syndrome. These challenges include increasing global prevalence of obesity and diabetes; increasing use of exogenous glucocorticoids, which cause a Cushing syndrome phenotype; the confusion caused by nonpathologic Hypercortisolism not associated with Cushing syndrome, which may present with symptoms consistent with Cushing syndrome; and difficulty identifying pathologic Hypercortisolism when it is extremely mild or cyclic or in renal failure, incidental adrenal masses, and pregnancy. Careful choice of screening tests, consideration of confounding conditions, and repeated testing when the results are ambiguous improve the accuracy of diagnosis.
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cushing s syndrome update on signs symptoms and biochemical screening
European Journal of Endocrinology, 2015Co-Authors: Lynnette K NiemanAbstract:Endogenous pathologic Hypercortisolism, or Cushing’s syndrome, is associated with poor quality of life, morbidity, and increased mortality. Early diagnosis may mitigate against this natural history of the disorder. The clinical presentation of Cushing’s syndrome varies, in part related to the extent and duration of cortisol excess. When Hypercortisolism is severe, its signs and symptoms are unmistakable. However, most of the signs and symptoms of Cushing’s syndrome are common in the general population (e.g., hypertension and weight gain) and not all are present in every patient. In addition to classical features of glucocorticoid excess, such as proximal muscle weakness and wide purple striae, patients may present with the associated comorbidities that are caused by Hypercortisolism. These include cardiovascular disease, thromboembolic disease, psychiatric and cognitive deficits, and infections. As a result, internists and generalists must consider Cushing’s syndrome as a cause, and endocrinologists should search for and treat these comorbidities. Recommended tests to screen for Cushing’s syndrome include 1 mg dexamethasone suppression, urine free cortisol, and late night salivary cortisol. These may be slightly elevated in patients with physiologic Hypercortisolism, which should be excluded, along with exogenous glucocorticoid use. Each screening test has caveats and the choice of tests should be individualized based on each patient’s characteristics and lifestyle. The objective of this review is to update the readership on the clinical and biochemical features of Cushing’s syndrome that are useful when evaluating patients for this diagnosis.
Jens Otto Lunde Jørgensen - One of the best experts on this subject based on the ideXlab platform.
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Hypercortisolism in Newly Diagnosed Type 2 Diabetes: A Prospective Study of 384 Newly Diagnosed Patients.
Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme, 2018Co-Authors: Charlotte Steffensen, Olaf M. Dekkers, Johanne Lyhne, Bodil Ginnerup Pedersen, Finn Rasmussen, Jørgen Rungby, Per Løgstrup Poulsen, Jens Otto Lunde JørgensenAbstract:Cross-sectional studies in small and selected populations report a high prevalence of Hypercortisolism in patients with type 2 diabetes (T2D), which could have therapeutic implications, if confirmed. We therefore estimated the prevalence of Hypercortisolism in a large and unselected cohort of recently diagnosed T2D patients. Consecutive patients with recently diagnosed T2D first underwent an overnight dexamethasone (1 mg) suppression test (OD). Patients not suppressing serum cortisol ≤50 nmol/l proceeded with a 48-h low dose dexamethasone suppression test (LDDST) and 24-h urinary free cortisol collection (UFC). Patients with elevated cortisol levels according to LDDST and/or UFC underwent imaging guided by plasma ACTH levels, and assessment of bone mineral density. A total of 384 T2D patients (232male/152 females) with a mean age of 60±10 years were included. Eighty-five (22%) patients suppressed incompletely to OD of whom 20 (5%) failed to suppress after LDDST and/or had elevated UFC (=Hypercortisolism). Patients with Hypercortisolism did not differ as regards age, BMI, HbA1c, T-score or blood pressure, but a higher proportion of them received antihypertensive treatment (100% vs. 64%, p=0.001). Imaging revealed adrenal adenoma(s) in 9 cases and a pituitary macroadenoma in 1 case. We found a 5% prevalence of Hypercortisolism in unselected, recently diagnosed T2D, which was not associated with a persuasive cushingoid phenotype. The clinical implications are therefore uncertain.
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DIAGNOSIS OF ENDOCRINE DISEASE: Prevalence of Hypercortisolism in type 2 diabetes patients: a systematic review and meta-analysis
European journal of endocrinology, 2016Co-Authors: Charlotte Steffensen, Alberto M. Pereira, Olaf M. Dekkers, Jens Otto Lunde JørgensenAbstract:OBJECTIVE Type 2 diabetes (T2D) and Cushing's syndrome (CS) share clinical characteristics, and several small studies have recorded a high prevalence of Hypercortisolism in T2D, which could have therapeutic implications. We aimed to assess the prevalence of endogenous Hypercortisolism in T2D patients. DESIGN Systematic review and meta-analysis of the literature. METHODS A search was performed in SCOPUS, MEDLINE, and EMBASE for original articles assessing the prevalence of endogenous Hypercortisolism and CS in T2D. Data were pooled in a random-effect logistic regression model and reported with 95% confidence intervals (95% CI). RESULTS Fourteen articles were included, with a total of 2827 T2D patients. The pooled prevalence of Hypercortisolism and CS was 3.4% (95% CI: 1.5-5.9) and 1.4% (95 CI: 0.4-2.9) respectively. The prevalence did not differ between studies of unselected patients and patients selected based on the presence of metabolic features such as obesity or poor glycemic control (P = 0.41 from meta-regression). Imaging in patients with Hypercortisolism (n = 102) revealed adrenal tumors and pituitary tumors in 52 and 14% respectively. CONCLUSIONS Endogenous Hypercortisolism is a relatively frequent finding in T2D, which may have therapeutic implications.
Motozumi Okamoto - One of the best experts on this subject based on the ideXlab platform.
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Subclinical Hypercortisolism in hospitalized patients with type 2 diabetes mellitus.
Endocrine journal, 2008Co-Authors: Takao Taniguchi, Akihiro Hamasaki, Motozumi OkamotoAbstract:Pre(sub)clinical Cushing's disease is a recently described entity defined by the autonomous secretion of ACTH and the absence of a cushingoid appearance. We screened 77 hospitalized patients with diabetes mellitus for subclinical Hypercortisolism and detected pre(sub)clinical Cushing's disease in 2 (2.6%) of them. In both patients, transsphenoidal surgery was performed and a microadenoma was removed. Their metabolic clearance rate of glucose measured by a glucose clamp study, an index of insulin sensitivity, significantly improved after surgery. Our results indicate that screening for subclinical Hypercortisolism in diabetic patients might be useful, as surgery improves glucose tolerance and insulin sensitivity.
Alfredo Scillitani - One of the best experts on this subject based on the ideXlab platform.
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GH secretion reserve in subclinical Hypercortisolism
Pituitary, 2013Co-Authors: Serena Palmieri, Paolo Beck-peccoz, Alfredo Scillitani, Valentina Morelli, Antonio Stefano Salcuni, Cristina Eller-vainicher, Elisa Cairoli, Volha V. Zhukouskaya, Iacopo ChiodiniAbstract:Purpose In overt Hypercortisolism, growth hormone (GH) secretion is decreased and normalizes after surgery. In subclinical Hypercortisolism (SH), GH secretion has been scarcely investigated. We assessed GH reserve in patients with and without SH and, in the former, also after recovery.
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Subclinical Hypercortisolism among outpatients referred for osteoporosis. Commentary
Annals of Internal Medicine, 2007Co-Authors: Lacopo Chiodini, Maura Arosio, Maria Lucia Mascia, Silvana Muscarella, Claudia Battista, Salvatore Minisola, Stefano Angelo Santini, Giuseppe Guglielmi, Vincenzo Carnevale, Alfredo ScillitaniAbstract:Background: Hypercortisolism is known to cause osteoporosis. Objective: To evaluate the prevalence of subclinical Hypercortisolism in participants referred for evaluation of osteoporosis. Design: Cross-sectional study. Setting: Two community hospitals and research institutes in Italy. Patients: 219 patients without clinically overt Hypercortisolism or other secondary causes of osteoporosis who were referred for evaluation of osteoporosis between January 2005 and December 2005. Measurements: Bone mineral density was measured by using dual-energy x-ray absorptiometry, and Hypercortisolism was assessed with serum cortisol levels after a dexamethasone suppression test. Also measured were 24-hour urinary free cortisol levels and midnight plasma cortisol levels. Results: Seven of 65 patients with T-scores of 2.5 or less and vertebral fractures had subclinical Hypercortisolism (prevalence, 10.8% [95% Cl, 3.23% to 18.31%]). This prevalence was 4.8% (Cl, 1.32% to 8.20%) among patients with osteoporosis. In multivariable analyses adjusted for age, sex, and body mass index, a positive dexamethasone suppression test result was associated with the presence of osteoporosis (odds ratio, 3.37 [Cl, 1.78 to 6.43]; P< 0.001) and vertebral fractures (odds ratio, 1.70 [Cl, 1.04 to 2.79]; P = 0.035). Limitations: The study was conducted in a referral setting; its findings may not apply to the general population. Conclusions: Subclinical Hypercortisolism may be more common than is generally recognized in patients with osteoporosis in whom secondary causes of osteoporosis have been excluded.
