[Endogenous Cushing's syndrome: clinical and laboratorial features in 73 cases].
We studied clinical and laboratorial features of 73 patients with endogenous Cushing's syndrome, subdivided as follows: 46 (63%) with Cushing's disease (CD), 21 (28.7%) with an adrenal tumor and 6 (8.2%) with ectopic ACTH secretion (EAS). The rate of typical manifestations of hypercortisolism was similar regardless its etiology. In 100% of cases of Cushing's syndrome we observed serum cortisol levels greater than 1.8 microg/dL in low-dose dexamethasone (DMS) suppression tests, as well as elevation of serum or salivary midnight cortisol. However, urinary free cortisol was normal in 11.5% of patients. ACTH levels were suppressed in patients with adrenal tumors, normal or high in CD and always high in EAS. In the 8-mg overnight DMS suppression test, serum cortisol suppression > 50% was observed in 78.2% of cases of CD and in 33.3% of subjects with EAS, while an 80% suppression was only seen in CD. After stimulation with CRH or DDAVP an ACTH increase > 35% occurred in 81% of individuals with CD and 16.6% of those with EAS, while an ACTH increase > 50 achieved 100% specificity. Moreover, the combination of serum cortisol suppression > 50% and an ACTH increase > 35% in both tests only occurred in Cushing's disease. Pituitary magnetic resonance imaging identified 100% of macroadenomas and 59.4% of microadenomas in patients with CD. Among 10 patients that underwent bilateral inferior petrosal sinus sampling, a central-to-peripheral ACTH gradient > 3 after CRH or DDAVP had 90% sensitivity and 100% specificity for Cushing's disease.
Serviço de Endocrinologia, Hospital das Clínicas, UFPE.
Lucio
L
Vilar
Luciana A
LA
Naves
Maria da Conceição
Mda C
Freitas
Eliane
E
Moura
Viviane
V
Canadas
Edmundo
E
Leal
Luciano
L
Teixeira
Amaro
A
Gusmão
Vera
V
Santos
Renata
R
Campos
Marise
M
Lima
Renata
R
Paiva
José Luciano
JL
Albuquerque
Célia S
CS
Egito
Carlos A
CA
Botelho
Ruy
R
Lyra
Monalisa F
MF
Azevedo
Luiz Augusto
LA
Casulari
D000182:ACTH Syndrome, Ectopic / Q000175:diagnosis* / Q000209:etiology; D000236:Adenoma / Q000175:diagnosis; D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D003907:Dexamethasone / Q000008:administration & dosage; D003937:Diagnosis, Differential; D004812:Epidemiologic Methods; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000652:urine; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D012737:Sex Factors
D005938:Glucocorticoids; D003907:Dexamethasone; D006854:Hydrocortisone