Skip to main content
SpringerLink
Log in

Clinical, Laboratory, and Radiological Diagnosis of Hypercortisolism

  • Chapter
  • First Online:
Diagnosis and Management of Endocrine Disorders in Interventional Radiology

  • 419 Accesses

Abstract

Hypercortisolism and its clinical manifestations, known as Cushing’s syndrome, can be caused by the administration of exogenous corticosteroids or several endogenous conditions that result in cortisol excess. Endogenous etiologies are uncommon, but clinicians must recognize the constellation of signs and symptoms to prevent significant morbidity and mortality from the diseases. Clinical suspicion of endogenous hypercortisolism leads to screening with laboratory testing. Validated tests include the 24-hour urine-free cortisol, the low-dose dexamethasone suppression test, or the late-night salivary-free cortisol. Once hypercortisolism is definitively diagnosed, the clinician then attempts to define the etiology using a combination of dynamic laboratory testing and imaging. Etiologies are stratified as adrenocorticotropic hormone (ACTH) dependent or independent. ACTH-dependent etiologies include ACTH-producing pituitary adenomas and ectopic ACTH syndromes. ACTH-independent etiologies include adrenal adenomas, adrenocortical carcinomas, and bilateral nodular adrenal diseases. Dynamic laboratory tests include the corticotropin-releasing hormone test and the high-dose dexamethasone suppression test. Imaging studies include thoracic and abdominal computed tomography, pituitary magnetic resonance imaging, and radionuclide-based imaging techniques such as F-18 fluorodeoxyglucose or Gallium-68 DOTA-peptide positron emission tomography. Invasive tests such as inferior petrosal sinus sampling and adrenal venous sampling are not discussed in this chapter.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Lindholm J, Juul S, Jørgensen JO, Astrup J, Bjerre P, Feldt-Rasmussen U, Hagen C, Jørgensen J, Kosteljanetz M, Kristensen L, Laurberg P, Schmidt K, Weeke J. Incidence and late prognosis of Cushing’s syndrome: a population-based study. J Clin Endocrinol Metab. 2001;86(1):117–23.

    CAS  PubMed  Google Scholar 

  2. Bolland MJ, Holdaway IM, Berkeley JE, Lim S, Dransfield WJ, Conaglen JV, Croxson MS, Gamble GD, Hunt PJ, Toomath RJ. Mortality and morbidity in Cushing’s syndrome in New Zealand. Clin Endocrinol. 2011;75(4):436–42.

    Article  Google Scholar 

  3. Steffensen C, Bak AM, Rubeck KZ, Jørgensen JO. Epidemiology of Cushing’s syndrome. Neuroendocrinology. 2010;92(Suppl 1):1–5.

    Article  CAS  PubMed  Google Scholar 

  4. Valassi E, Santos A, Yaneva M, Tóth M, Strasburger CJ, Chanson P, Wass JA, Chabre O, Pfeifer M, Feelders RA, Tsagarakis S, Trainer PJ, Franz H, Zopf K, Zacharieva S, Lamberts SW, Tabarin A, Webb SM, ERCUSYN Study Group. The European Registry on Cushing’s syndrome: 2-year experience. Baseline demographic and clinical characteristics. Eur J Endocrinol. 2011;165(3):383–92.

    Article  CAS  PubMed  Google Scholar 

  5. Porterfield JR, Thompson GB, Young WF Jr, Chow JT, Fryrear RS, van Heerden JA, Farley DR, Atkinson JL, Meyer FB, Abboud CF, Nippoldt TB, Natt N, Erickson D, Vella A, Carpenter PC, Richards M, Carney JA, Larson D, Schleck C, Churchward M, Grant CS. Surgery for Cushing’s syndrome: an historical review and recent ten-year experience. World J Surg. 2008;32(5):659–77.

    Article  PubMed  Google Scholar 

  6. Graversen D, Vestergaard P, Stochholm K, Gravholt CH, Jørgensen JO. Mortality in Cushing’s syndrome: a systematic review and meta-analysis. Eur J Intern Med. 2012;23(3):278–82.

    Article  CAS  PubMed  Google Scholar 

  7. Yaneva M, Kalinov K, Zacharieva S. Mortality in Cushing’s syndrome: data from 386 patients from a single tertiary referral center. Eur J Endocrinol. 2013;169(5):621–7.

    Article  CAS  PubMed  Google Scholar 

  8. Catargi B, Rigalleau V, Poussin A, Ronci-Chaix N, Bex V, Vergnot V, Gin H, Roger P, Tabarin A. Occult Cushing’s syndrome in type-2 diabetes. J Clin Endocrinol Metab. 2003;88(12):5808–13.

    Article  CAS  PubMed  Google Scholar 

  9. Chiodini I, Mascia ML, Muscarella S, Battista C, Minisola S, Arosio M, Santini SA, Guglielmi G, Carnevale V, Scillitani A. Subclinical hypercortisolism among outpatients referred for osteoporosis. Ann Intern Med. 2007;147(8):541–8.

    Article  PubMed  Google Scholar 

  10. Nieman LK, Biller BM, Findling JW, Newell-Price J, Savage MO, Stewart PM, Montori VM. The diagnosis of Cushing’s syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2008;93(5):1526–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Katznelson L, Bogan JS, Trob JR, Schoenfeld DA, Hedley-Whyte ET, Hsu DW, Zervas NT, Swearingen B, Sleeper M, Klibanski A. Biochemical assessment of Cushing’s disease in patients with corticotroph macroadenomas. J Clin Endocrinol Metab. 1998;83(5):1619–23.

    CAS  PubMed  Google Scholar 

  12. Zhou Y, Zhang X, Klibanski A. Genetic and epigenetic mutations of tumor suppressive genes in sporadic pituitary adenoma. Mol Cell Endocrinol. 2014;386(1–2):16–33.

    Article  CAS  PubMed  Google Scholar 

  13. Huizenga NA, de Lange P, Koper JW, Clayton RN, Farrell WE, van der Lely AJ, Brinkmann AO, de Jong FH, Lamberts SW. Human adrenocorticotropin-secreting pituitary adenomas show frequent loss of heterozygosity at the glucocorticoid receptor gene locus. J Clin Endocrinol Metab. 1998;83(3):917–21.

    CAS  PubMed  Google Scholar 

  14. Raff H, Findling JW. A physiologic approach to diagnosis of the Cushing syndrome. Ann Intern Med. 2003;138(12):980–91.

    Article  PubMed  Google Scholar 

  15. Aniszewski JP, Young WF Jr, Thompson GB, Grant CS, van Heerden JA. Cushing syndrome due to ectopic adrenocorticotropic hormone secretion. World J Surg. 2001;25(7):934–40.

    Article  CAS  PubMed  Google Scholar 

  16. de Keyzer Y, Lenne F, Auzan C, Jégou S, René P, Vaudry H, Kuhn JM, Luton JP, Clauser E, Bertagna X. The pituitary V3 vasopressin receptor and the corticotroph phenotype in ectopic ACTH syndrome. J Clin Invest. 1996;97(5):1311–8.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Zilbermint M, Stratakis CA. Protein kinase A defects and cortisol-producing adrenal tumors. Curr Opin Endocrinol Diabetes Obes. 2015;22(3):157–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Bourdeau I, Lampron A, Costa MH, Tadjine M, Lacroix A. Adrenocorticotropic hormone-independent Cushing’s syndrome. Curr Opin Endocrinol Diabetes Obes. 2007;14(3):219–25.

    Article  CAS  PubMed  Google Scholar 

  19. Allolio B, Fassnacht M. Clinical review: adrenocortical carcinoma: clinical update. J Clin Endocrinol Metab. 2006;91(6):2027–37.

    Article  CAS  PubMed  Google Scholar 

  20. Luton JP, Cerdas S, Billaud L, Thomas G, Guilhaume B, Bertagna X, Laudat MH, Louvel A, Chapuis Y, Blondeau P, et al. Clinical features of adrenocortical carcinoma, prognostic factors, and the effect of mitotane therapy. N Engl J Med. 1990;322(17):1195–201.

    Article  CAS  PubMed  Google Scholar 

  21. Koch CA, Pacak K, Chrousos GP. The molecular pathogenesis of hereditary and sporadic adrenocortical and adrenomedullary tumors. J Clin Endocrinol Metab. 2002;87(12):5367–84.

    Article  CAS  PubMed  Google Scholar 

  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(8):2930–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. De Venanzi A, Alencar GA, Bourdeau I, Fragoso MC, Lacroix A. Primary bilateral macronodular adrenal hyperplasia. Curr Opin Endocrinol Diabetes Obes. 2014;21(3):177–84.

    Article  PubMed  Google Scholar 

  24. Stratakis CA, Kirschner LS, Carney JA. Clinical and molecular features of the Carney complex: diagnostic criteria and recommendations for patient evaluation. J Clin Endocrinol Metab. 2001;86(9):4041–6.

    Article  CAS  PubMed  Google Scholar 

  25. Wajchenberg BL, Bosco A, Marone MM, Levin S, Rocha M, Lerário AC, Nery M, Goldman J, Liberman B. Estimation of body fat and lean tissue distribution by dual energy X-ray absorptiometry and abdominal body fat evaluation by computed tomography in Cushing’s disease. J Clin Endocrinol Metab. 1995;80(9):2791–4.

    CAS  PubMed  Google Scholar 

  26. Corenblum B, Kwan T, Gee S, Wong NC. Bedside assessment of skin-fold thickness. A useful measurement for distinguishing Cushing’s disease from other causes of hirsutism and oligomenorrhea. Arch Intern Med. 1994;154(7):777–81.

    Article  CAS  PubMed  Google Scholar 

  27. Pivonello R, Isidori AM, De Martino MC, Newell-Price J, Biller BM, Colao A. Complications of Cushing’s syndrome: state of the art. Lancet Diabetes Endocrinol. 2016;4(7):611–29.

    Article  CAS  PubMed  Google Scholar 

  28. Dekkers OM, Horváth-Puhó E, Jørgensen JO, Cannegieter SC, Ehrenstein V, Vandenbroucke JP, Pereira AM, Sørensen HT. Multisystem morbidity and mortality in Cushing’s syndrome: a cohort study. J Clin Endocrinol Metab. 2013;98(6):2277–84.

    Article  CAS  PubMed  Google Scholar 

  29. Mancini T, Kola B, Mantero F, Boscaro M, Arnaldi G. High cardiovascular risk in patients with Cushing’s syndrome according to 1999 WHO/ISH guidelines. Clin Endocrinol. 2004;61(6):768–77.

    Article  Google Scholar 

  30. Van Zaane B, Nur E, Squizzato A, Dekkers OM, Twickler MT, Fliers E, Gerdes VE, Büller HR, Brandjes DP. Hypercoagulable state in Cushing’s syndrome: a systematic review. J Clin Endocrinol Metab. 2009;94(8):2743–50.

    Article  PubMed  CAS  Google Scholar 

  31. Ntali G, Asimakopoulou A, Siamatras T, Komninos J, Vassiliadi D, Tzanela M, Tsagarakis S, Grossman AB, Wass JA, Karavitaki N. Mortality in Cushing’s syndrome: systematic analysis of a large series with prolonged follow-up. Eur J Endocrinol. 2013;169(5):715–23.

    Article  CAS  PubMed  Google Scholar 

  32. Sarlis NJ, Chanock SJ, Nieman LK. Cortisolemic indices predict severe infections in Cushing syndrome due to ectopic production of adrenocorticotropin. J Clin Endocrinol Metab. 2000;85(1):42–7.

    CAS  PubMed  Google Scholar 

  33. Pivonello R, Simeoli C, De Martino MC, Cozzolino A, De Leo M, Iacuaniello D, Pivonello C, Negri M, Pellecchia MT, Iasevoli F, Colao A. Neuropsychiatric disorders in Cushing’s syndrome. Front Neurosci. 2015;9:129.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Elamin MB, Murad MH, Mullan R, Erickson D, Harris K, Nadeem S, Ennis R, Erwin PJ, Montori VM. Accuracy of diagnostic tests for Cushing’s syndrome: a systematic review and metaanalyses. J Clin Endocrinol Metab. 2008;93(5):1553–62.

    Article  CAS  PubMed  Google Scholar 

  35. Arnaldi G, Angeli A, Atkinson AB, Bertagna X, Cavagnini F, Chrousos GP, Fava GA, Findling JW, Gaillard RC, Grossman AB, Kola B, Lacroix A, Mancini T, Mantero F, Newell-Price J, Nieman LK, Sonino N, Vance ML, Giustina A, Boscaro M. Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab. 2003;88(12):5593–602.

    Article  CAS  PubMed  Google Scholar 

  36. Lacroix A, Feelders RA, Stratakis CA, Nieman LK. Cushing’s syndrome. Lancet. 2015;386(9996):913–27.

    Article  CAS  PubMed  Google Scholar 

  37. Reimondo G, Paccotti P, Minetto M, Termine A, Stura G, Bergui M, Angeli A, Terzolo M. The corticotrophin-releasing hormone test is the most reliable noninvasive method to differentiate pituitary from ectopic ACTH secretion in Cushing’s syndrome. Clin Endocrinol. 2003;58(6):718–24.

    Article  CAS  Google Scholar 

  38. Dichek HL, Nieman LK, Oldfield EH, Pass HI, Malley JD, Cutler GB Jr. A comparison of the standard high dose dexamethasone suppression test and the overnight 8-mg dexamethasone suppression test for the differential diagnosis of adrenocorticotropin-dependent Cushing’s syndrome. J Clin Endocrinol Metab. 1994;78(2):418–22.

    Article  CAS  PubMed  Google Scholar 

  39. Peck WW, Dillon WP, Norman D, Newton TH, Wilson CB. High-resolution MR imaging of pituitary microadenomas at 1.5 T: experience with Cushing disease. AJR Am J Roentgenol. 1989;152(1):145–51.

    Article  CAS  PubMed  Google Scholar 

  40. Sakamoto Y, Takahashi M, Korogi Y, Bussaka H, Ushio Y. Normal and abnormal pituitary glands: gadopentetate dimeglumine-enhanced MR imaging. Radiology. 1991;178(2):441–5.

    Article  CAS  PubMed  Google Scholar 

  41. Friedman TC, Zuckerbraun E, Lee ML, Kabil MS, Shahinian H. Dynamic pituitary MRI has high sensitivity and specificity for the diagnosis of mild Cushing’s syndrome and should be part of the initial workup. Horm Metab Res. 2007;39(6):451–6.

    Article  CAS  PubMed  Google Scholar 

  42. Tabarin A, Laurent F, Catargi B, Olivier-Puel F, Lescene R, Berge J, et al. Comparative evaluation of conventional and dynamic magnetic resonance imaging of the pituitary gland for the diagnosis of Cushing’s disease. Clin Endocrinol. 1998;49(3):293–300.

    Article  CAS  Google Scholar 

  43. Grober Y, Grober H, Wintermark M, Jane JA, Oldfield EH. Comparison of MRI techniques for detecting microadenomas in Cushing’s disease. J Neurosurg. 2018;128(4):1051–7.

    Article  PubMed  Google Scholar 

  44. Lang M, Habboub G, Moon D, Bandyopadhyay A, Silva D, Kennedy L, et al. Comparison of constructive interference in steady-state and T1-weighted MRI sequence at detecting pituitary adenomas in Cushing’s disease patients. J Neurol Surg B Skull Base. 2018;79(6):593–8.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Ajlan A, Achrol AS, Albakr A, Feroze AH, Westbroek EM, Hwang P, et al. Cavernous sinus involvement by pituitary adenomas: clinical implications and outcomes of endoscopic endonasal resection. J Neurol Surg B Skull Base. 2017;78(3):273–82.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Knosp E, Steiner E, Kitz K, Matula C. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery. 1993;33(4):610–7; discussion 7–8

    CAS  PubMed  Google Scholar 

  47. Micko AS, Wohrer A, Wolfsberger S, Knosp E. Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification. J Neurosurg. 2015;122(4):803–11.

    Article  PubMed  Google Scholar 

  48. Buchy M, Lapras V, Rabilloud M, Vasiljevic A, Borson-Chazot F, Jouanneau E, et al. Predicting early post-operative remission in pituitary adenomas: evaluation of the modified knosp classification. Pituitary. 2019;22(5):467–75.

    Article  CAS  PubMed  Google Scholar 

  49. Cottier JP, Destrieux C, Brunereau L, Bertrand P, Moreau L, Jan M, et al. Cavernous sinus invasion by pituitary adenoma: MR imaging. Radiology. 2000;215(2):463–9.

    Article  CAS  PubMed  Google Scholar 

  50. Newell-Price J, Bertagna X, Grossman AB, Nieman LK. Cushing’s syndrome. Lancet. 2006;367(9522):1605–17.

    Article  CAS  PubMed  Google Scholar 

  51. Wagner-Bartak NA, Baiomy A, Habra MA, Mukhi SV, Morani AC, Korivi BR, et al. Cushing syndrome: diagnostic workup and imaging features, with clinical and pathologic correlation. AJR Am J Roentgenol. 2017;209(1):19–32.

    Article  PubMed  Google Scholar 

  52. Ejaz S, Vassilopoulou-Sellin R, Busaidy NL, Hu MI, Waguespack SG, Jimenez C, et al. Cushing syndrome secondary to ectopic adrenocorticotropic hormone secretion: the University of Texas MD Anderson Cancer Center Experience. Cancer. 2011;117(19):4381–9.

    Article  CAS  PubMed  Google Scholar 

  53. Zwiebel BR, Austin JH, Grimes MM. Bronchial carcinoid tumors: assessment with CT of location and intratumoral calcification in 31 patients. Radiology. 1991;179(2):483–6.

    Article  CAS  PubMed  Google Scholar 

  54. Jeung MY, Gasser B, Gangi A, Charneau D, Ducroq X, Kessler R, et al. Bronchial carcinoid tumors of the thorax: spectrum of radiologic findings. Radiographics. 2002;22(2):351–65.

    Article  PubMed  Google Scholar 

  55. Jiang Y, Hou G, Cheng W. The utility of 18F-FDG and 68Ga-DOTA-peptide PET/CT in the evaluation of primary pulmonary carcinoid: a systematic review and meta-analysis. Medicine (Baltimore). 2019;98(10):e14769.

    Article  CAS  Google Scholar 

  56. Tatci E, Ozmen O, Gokcek A, Biner IU, Ozaydin E, Kaya S, et al. 18F-FDG PET/CT rarely provides additional information other than primary tumor detection in patients with pulmonary carcinoid tumors. Ann Thorac Med. 2014;9(4):227–31.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Deppen SA, Liu E, Blume JD, Clanton J, Shi C, Jones-Jackson LB, et al. Safety and efficacy of 68Ga-DOTATATE PET/CT for diagnosis, staging, and treatment management of neuroendocrine tumors. J Nucl Med. 2016;57(5):708–14.

    Article  CAS  PubMed  Google Scholar 

  58. Carter BW, Glisson BS, Truong MT, Erasmus JJ. Small cell lung carcinoma: staging, imaging, and treatment considerations. Radiographics. 2014;34(6):1707–21.

    Article  PubMed  Google Scholar 

  59. Lee D, Rho JY, Kang S, Yoo KJ, Choi HJ. CT findings of small cell lung carcinoma: can recognizable features be found? Medicine (Baltimore). 2016;95(47):e5426.

    Article  Google Scholar 

  60. Kut V, Spies W, Spies S, Gooding W, Argiris A. Staging and monitoring of small cell lung cancer using [18F]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET). Am J Clin Oncol. 2007;30(1):45–50.

    Article  PubMed  Google Scholar 

  61. Lewis RB, Lattin GE Jr, Paal E. Pancreatic endocrine tumors: radiologic-clinicopathologic correlation. Radiographics. 2010;30(6):1445–64.

    Article  PubMed  Google Scholar 

  62. Tamm EP, Bhosale P, Lee JH, Rohren EM. State-of-the-art imaging of pancreatic neuroendocrine tumors. Surg Oncol Clin N Am. 2016;25(2):375–400.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Levy AD, Sobin LH. From the archives of the AFIP: gastrointestinal carcinoids: imaging features with clinicopathologic comparison. Radiographics. 2007;27(1):237–57.

    Article  PubMed  Google Scholar 

  64. Ganeshan D, Bhosale P, Yang T, Kundra V. Imaging features of carcinoid tumors of the gastrointestinal tract. AJR Am J Roentgenol. 2013;201(4):773–86.

    Article  PubMed  Google Scholar 

  65. Giambelluca D, Cannella R, Midiri M, Salvaggio G. The “spoke wheel” sign in mesenteric carcinoid. Abdom Radiol (NY). 2019;44(5):1949–50.

    Article  Google Scholar 

  66. Evangelista L, Ravelli I, Bignotto A, Cecchin D, Zucchetta P. Ga-68 DOTA-peptides and F-18 FDG PET/CT in patients with neuroendocrine tumor: a review. Clin Imaging. 2020;67:113–6.

    Article  PubMed  Google Scholar 

  67. Lattin GE Jr, Sturgill ED, Tujo CA, Marko J, Sanchez-Maldonado KW, Craig WD, et al. From the radiologic pathology archives: adrenal tumors and tumor-like conditions in the adult: radiologic-pathologic correlation. Radiographics. 2014;34(3):805–29.

    Article  PubMed  Google Scholar 

  68. Boland GW, Lee MJ, Gazelle GS, Halpern EF, McNicholas MM, Mueller PR. Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. AJR Am J Roentgenol. 1998;171(1):201–4.

    Article  CAS  PubMed  Google Scholar 

  69. Blake MA, Cronin CG, Boland GW. Adrenal imaging. AJR Am J Roentgenol. 2010;194(6):1450–60.

    Article  PubMed  Google Scholar 

  70. Papakokkinou E, Jakobsson H, Sakinis A, Muth A, Wangberg B, Ehn O, et al. Adrenal venous sampling in patients with ACTH-independent hypercortisolism. Endocrine. 2019;66(2):338–48.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Rockall AG, Babar SA, Sohaib SA, Isidori AM, Diaz-Cano S, Monson JP, et al. CT and MR imaging of the adrenal glands in ACTH-independent Cushing syndrome. Radiographics. 2004;24(2):435–52.

    Article  PubMed  Google Scholar 

  72. Bharwani N, Rockall AG, Sahdev A, Gueorguiev M, Drake W, Grossman AB, et al. Adrenocortical carcinoma: the range of appearances on CT and MRI. AJR Am J Roentgenol. 2011;196(6):W706–14.

    Article  PubMed  Google Scholar 

  73. Fishman EK, Deutch BM, Hartman DS, Goldman SM, Zerhouni EA, Siegelman SS. Primary adrenocortical carcinoma: CT evaluation with clinical correlation. AJR Am J Roentgenol. 1987;148(3):531–5.

    Article  CAS  PubMed  Google Scholar 

  74. Elsayes KM, Mukundan G, Narra VR, Lewis JS Jr, Shirkhoda A, Farooki A, et al. Adrenal masses: MR imaging features with pathologic correlation. Radiographics. 2004;24(Suppl 1):S73–86.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Endocrinology, University of North Carolina, Chapel Hill, NC, USA

    Paul A. Guido

  2. Division of Neuroradiology, Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Carlos A. Zamora

Authors
  1. Paul A. Guido
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlos A. Zamora
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul A. Guido .

Editor information

Editors and Affiliations

  1. Division of Vascular and Interventional RadiologyDepartment of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA

    Hyeon Yu

  2. Division of Vascular and Interventional RadiologyDepartment of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA

    Charles T. Burke

  3. Division of Vascular and Interventional RadiologyDepartment of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA

    Clayton W. Commander

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Guido, P.A., Zamora, C.A. (2022). Clinical, Laboratory, and Radiological Diagnosis of Hypercortisolism. In: Yu, H., Burke, C.T., Commander, C.W. (eds) Diagnosis and Management of Endocrine Disorders in Interventional Radiology. Springer, Cham. https://doi.org/10.1007/978-3-030-87189-5_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-87189-5_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-87188-8

  • Online ISBN: 978-3-030-87189-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation