Skip to main content
SpringerLink
Log in

Clinical laboratory findings and results of therapy in 55 patients with Cushing’s syndrome

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

In this study, 55 patients with Cushing’s syndrome (CS) (50 female, 5 male; mean age 34±12.3 yr) who attended our clinics between the years 1983 and 2000 were retrospectively evaluated for clinical and laboratory features and modalities and results of therapy, due to a few similar studies over the last ten years. Cushing’s disease was diagnosed in 39 patients (71%), adrenal adenoma in 13 patients (23.6%) and adrenal carcinoma in 3 patients (5.5%). Centripedal obesity, moon face, hypertension, hirsutism and purplish stria were the most frequent findings. Loss of normal serum F circadian rhythm was found in all patients with CS. The overnight 1 mg oral dexamethasone suppression test and low-dose dexamethasone suppression test (LDDST) yielded 100% and 100% diagnostic sensitivity for CS, respectively. Sensitivity and specivity of the high-dose dexamethasone suppression test (HDDST) in distinguishing Cushing’s disease was found to be 82% and 100%, respectively. All of the patients with adrenal CS were not suppressed with HDDST. Sellar CT and/or MRI accurately identified the tumor in 58% of these patients. Recurrence was observed in 3 (11%) of the 28 patients with Cushing’s disease, treated by transsphenoidal adenomectomy. Recurrence was diagnosed 1.5, 3 and 6 yr after the operation in these 3 patients. One patient had residue tumor. In our case series, bilateral adrenalectomy plus pituitary irradiation achieved the highest remission rate (100%) in Cushing’s disease. In 2 out of 4 patients (50%) treated by left adrenalectomy associated with pituitary irradiation, recurrence was observed. Panhypopituitarism due to tumor apoplexy was observed in one of the patients with Cushing’s disease. All of the patients with adrenal CS, the tumor was accurately localized with imaging methods before the operation. The appropriate operative procedure resulted in complete remission in patients with adrenal adenoma. Consequently, Cushing’s disease was the most common form of CS. The overnight 1 mg oral DST and 24-h urine free F excretion (UFC) as screening tests, 2-day LDDST as diagnostic test and 2-day HDDST as differential diagnostic test were good studies. More successful outcomes have been achieved in treatment of Cushing’s disease with the development of pituitary surgery in the recent years, as well as in our case series. Surgery is also curative for adrenal adenoma patients. Survival remains poor among carcinoma patients.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Daitch J.A., Goldfarb D.A., Novick A.C. Cleveland Clinic Experience with Adrenal Cushing’s Syndrome. J. Urol. 1997, 158: 2051–2055.

    Article  PubMed  CAS  Google Scholar 

  2. Boscaro M., Barzon L., Fallo F., Sonino L. Cushing’s syndrome. Lancet 2001, 357: 783–791.

    Article  PubMed  CAS  Google Scholar 

  3. Cushing H. The basophil adenomas of the pituitary body and their clinical manifestations (pituitary basophilism). Bull John Hopkins Hosp. 1932, 50: 137–195.

    Google Scholar 

  4. Cushing H. The pituitary body and its disorders: Clinical states produced by disorders of the hypophysis cerebri. J.B. Lippincott, Philadelphia, 1912.

    Google Scholar 

  5. Orth D.N. Cushing’s syndrome. N. Engl. J. Med. 1995, 332: 791–802.

    Article  PubMed  CAS  Google Scholar 

  6. Yanovski J.A., Cutler G.B. Glucocorticoid action and the clinical features of Cushing’s syndrome. Endocrinol. Metab. Clin. North Am. 1994, 23: 487–509.

    PubMed  CAS  Google Scholar 

  7. Meier C.A., Biller B.M. Clinical and biochemical evaluation of Cushing’s syndrome. Endocrinol. Metab. Clin. North Am. 1997, 26: 741–762.

    Article  PubMed  CAS  Google Scholar 

  8. Findling J., Aron D.C., Tyrrell B. Glucocorticoids and adrenal androgens. In: Greenspan F.S., Strewler G.J. (Eds.), Basic and Clinical Endocrinology, Stamford, Appleton Lange, 1997, p. 317.

    Google Scholar 

  9. Keller-Wood M.E., Dallman M.F. Corticosteroid inhibition of ACTH secretion. Endocr. Rev. 1984, 5: 1–24.

    Article  PubMed  CAS  Google Scholar 

  10. Feleke Y., Abdulkadir J., Johnson O. et al. Cushing’s syndrome: a ten year experience at Tikuur Anbassa hospital. Ethiop. Med. J. 1998, 36: 19–26.

    PubMed  CAS  Google Scholar 

  11. Trainer P.J., Grossman A. The diagnosis and differential diagnosis of Cushing’s syndrome. Clin. Endocrinol. 1991, 34: 317–330.

    Article  CAS  Google Scholar 

  12. Grossman A.B., Howlet T.A., Perry L. et al. CRF in the differential diagnosis of Cushing’s syndrome: a comparison with the dexamethasone suppression test. Clin. Endocrinol. 1988, 29: 167–178.

    Article  CAS  Google Scholar 

  13. Flack M.R., Oldfield E.H., Cutler G.B. Jr. et al. Urine free cortisol in the high-dose dexamethasone suppression test for the differential diagnosis of the Cushing’s syndrome. Ann. Intern. Med. 1992, 116: 211–217.

    Article  PubMed  CAS  Google Scholar 

  14. Tyrell J.B., Findling J.W., Aron D.C., Fitzgerald P.A., Forsham P.H. An overnight high-dose dexamethasone suppression test for rapid differential diagnosis of Cushing’s syndrome. Ann. Intern. Med. 1986, 104: 180–186.

    Article  Google Scholar 

  15. Bruno O.D., Rossi M.A., Contreras L.N. et al. Nocturnal high-dose dexamethasone suppression test in the etiological disgnosis of Cushing’s syndrome. Acta Endocrinol. 1985, 109: 158–162.

    PubMed  CAS  Google Scholar 

  16. Findling J.W., Doppman J.L. Biochemical and radiological diagnosis of Cushing’s syndrome. Endocrinol. Metab. Clin. North Am. 1994, 23: 511–537.

    PubMed  CAS  Google Scholar 

  17. Trainer P.J., Rees L.H. Cushing’s syndrome: diagnosis and differential diagnosis. In: Bouloux P.-M.G.,. Rees L.H. (Eds.), Diagnostic Tests in Endocrinology and Diabetes Chapman and Hall Medical, London, 1994, p. 67.

    Google Scholar 

  18. Oldfield, E.H., Doppman J.L., Nieman L.K. et al. Petrosal sinus sampling with and without corticotropin-releasing hormone for the differential diagnosis of Cushing’s syndrome. N. Engl. J. Med. 1991, 325: 897–905.

    Article  PubMed  CAS  Google Scholar 

  19. Hardy J. Transsphenoidal hypophysectomy: neurosurgical techniques. J. Neurosurg. 1971, 34: 582–594.

    Article  PubMed  CAS  Google Scholar 

  20. Trainer P.J., Lawrie H.S., Verheist J. et al. Transsphenoidal resection in Cushing’s disease:undetectable serum cortisol as the definition of successful treatment. Clin. Endocrinol. 1993, 38: 73–78.

    Article  CAS  Google Scholar 

  21. Howlet T.A., Plowman P.N., Wass J.A.H. et al. Megavoltage pituitary irradiation in the management of Cushing’s disease and Nelson’s syndrome. Clin. Endocrinol. 1989, 31: 309–323.

    Article  Google Scholar 

  22. Samuels M.H., Lariaux D.L. Cushing’s syndrome and the nodular adrenal gland. Endocrinol. Metab. Clin. North Am. 1994, 23: 555–569.

    PubMed  CAS  Google Scholar 

  23. Orth D.N. Cushing’s syndrome. N. Engl. J. Med. 1995, 332: 791.

    Article  PubMed  CAS  Google Scholar 

  24. Bertagna C., Orth D.N. Clinical and laboratory findings and results of therapy in 58 patients with adrenocortical tumors admitted to a single medical center (1951 to 1978). Am. J. Med. 1981, 71: 855–875.

    Article  PubMed  CAS  Google Scholar 

  25. Nugent C.A., Nichols T., Tyler F.H. Diagnosis of Cushing’s syndrome: single dose dexamethasone supression test. Arch. Intern. Med. 1965, 116: 172–176.

    Article  PubMed  CAS  Google Scholar 

  26. Newel-Price J., Trainer P., Besser M. et al. The diagnosis and differential diagnosis of Cushing’s syndrome and pseudo- Cushing’s states. Endocr. Rev. 1998, 19: 647–72.

    Google Scholar 

  27. Findling J.W., Keohe M.E., Shaker J.L. et al. Routine inferior petrosal sinus sampling in the differential diagnosis of adrenocorticotropin (ACTH)-dependent Cushing’s syndrome: Early recognition of the occult ectopic ACTH syndrome. J. Clin. Endocrinol. Metab. 1991, 73: 408–413.

    Article  PubMed  CAS  Google Scholar 

  28. Tabarin A., Greselle J.F., San-Galli F. et al. Usefulness of the corticotropin-releasing hormone test during bilateral inferior petrosal sinus sampling for the diagnosis of Cushing’s disease. J. Clin. Endocrinol. Metab. 1991, 73: 53–59.

    Article  PubMed  CAS  Google Scholar 

  29. Peck W.W., Dillon W.P., Norman D. et al. High-resolution MR imaging of pituitary microadenomas at 1.5 T: experience with Cushing’s disease. Am. J. Radiol. 1989, 152: 145–151.

    CAS  Google Scholar 

  30. Lüdecke D.K. Transnasal microsurgery of Cushing’s disease 1990. Overview including personal experiences with 256 patients. Pathol. Res. Pract. 1991, 187: 608–612.

    Article  PubMed  Google Scholar 

  31. Marcovitz S., Wee R., Chan J., Hardy J. The diagnostic accuracy of preoperative CT scanning in the evalution of pituitary ACTH-secreting adenomas. Am. J. Roentgenol. 1987, 149: 803–806.

    Article  CAS  Google Scholar 

  32. Trainer P.J., Besser M. Cushing’s syndrome: Therapy directed at the adrenal glands. Endocrinol. Metab. Clin. North Am. 1994, 23: 571–584.

    PubMed  CAS  Google Scholar 

  33. Orth D.N., Kovacs W.J. The adrenal cortex. In: Wilson J.D., Foster D.W, Kronenberg H.M. Larsen P.R. (Eds.), Williams Textbook of Endocrinology, 9th edn. Philadelphia, W.B. Saunders, 1998, p.517.

    Google Scholar 

  34. Freda P.U., Wardlaw S.L. Diagnosis and treatment of pituitary tumors. J. Clin. Endocrinol. Metab 1999, 84: 3859–3866.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Division of Endocrinology and Metabolism, Karadeniz Technical University Faculty of Medicine, K.T.Ü. Tip Fakültesi, Iç Hastaliklari Anabilim Dali, 61080, Trabzon, Turkey

    Cihangir Erem, Y. Orhan & E. Sencer

  2. Department of Internal Medicine, Division of Endocrinology and Metabolism, 100. Yil University Faculty of Medicine, Van, Turkey

    E. Algün

  3. Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University Faculty of Medicine, Istanbul, Turkey

    N. Ozbey, A. Azezli, F. Aral, Y. Orhan, S. Molvalilar & E. Sencer

Authors
  1. Cihangir Erem
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Algün
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Ozbey
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Azezli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. Aral
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Y. Orhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Molvalilar
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. E. Sencer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cihangir Erem.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Erem, C., Algün, E., Ozbey, N. et al. Clinical laboratory findings and results of therapy in 55 patients with Cushing’s syndrome. J Endocrinol Invest 26, 65–72 (2003). https://doi.org/10.1007/BF03345125

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03345125

Key-words

Search

Navigation