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  1. Article ; Online: Recognition of Nonneoplastic Hypercortisolism in the Evaluation of Patients With Cushing Syndrome.

    Findling, James W / Raff, Hershel

    Journal of the Endocrine Society

    2023  Volume 7, Issue 8, Page(s) bvad087

    Abstract: The evaluation of suspected hypercortisolism is one of the most challenging problems in medicine. The signs and symptoms described by Dr Harvey Cushing are common and often create diagnostic confusion to even experienced endocrinologists. Cushing ... ...

    Abstract The evaluation of suspected hypercortisolism is one of the most challenging problems in medicine. The signs and symptoms described by Dr Harvey Cushing are common and often create diagnostic confusion to even experienced endocrinologists. Cushing syndrome is classically defined as neoplastic hypercortisolism resulting from an ACTH-secreting tumor or from autonomous secretion of excess cortisol associated with benign or malignant adrenal neoplasia. The increasing recognition of the negative cardiometabolic effects of mild cortisol excess without overt physical signs of Cushing syndrome has led to more screening for endogenous hypercortisolism in patients with adrenal nodular disease, osteoporosis, and the metabolic syndrome. However, sustained or intermittent activation of the dynamic hypothalamic-pituitary-adrenal axis caused by chemical (alcohol), inflammatory (chronic kidney disease), psychologic (major depression), and physical (starvation/chronic intense exercise) stimuli can result in clinical and/or biochemical features indistinguishable from neoplastic hypercortisolism. Nonneoplastic hypercortisolism (formerly known as pseudo-Cushing syndrome) has been recognized for more than 50 years and often causes diagnostic uncertainty. This expert consultation describes two patients with features of Cushing syndrome who were referred for inferior petrosal sinus sampling for the differential diagnosis of ACTH-dependent hypercortisolism. Both patients were discovered to have nonneoplastic hypercortisolism: one from a covert alcohol use disorder and the other to chronic kidney disease. This consultation emphasizes the value of a good history and physical examination, appropriate laboratory testing, and the desmopressin acetate stimulation test to aid in distinguishing neoplastic from nonneoplastic hypercortisolism.
    Language English
    Publishing date 2023-06-23
    Publishing country United States
    Document type Journal Article
    ISSN 2472-1972
    ISSN (online) 2472-1972
    DOI 10.1210/jendso/bvad087
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Book: Cushing's syndrome

    Findling, James W.

    (Endocrinology and metabolism clinics of North America ; 34,2)

    2005  

    Author's details guest ed. James W. Findling
    Series title Endocrinology and metabolism clinics of North America ; 34,2
    Collection
    Language English
    Size XV S., S. 257 - 519 : Ill., graph. Darst.
    Publisher Saunders
    Publishing place Philadelphia u.a.
    Publishing country United States
    Document type Book
    HBZ-ID HT014394023
    ISBN 1-4160-2687-8 ; 978-1-4160-2687-7
    Database Catalogue ZB MED Medicine, Health

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    In stock of ZB MED Cologne/Königswinter

    Shelf markLoan statusLocation
    Se 148 -34,2- verfügbar in Königswinter Königswinter

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  3. Article ; Online: Glucocorticoid Withdrawal Syndrome following treatment of endogenous Cushing Syndrome.

    He, Xin / Findling, James W / Auchus, Richard J

    Pituitary

    2022  Volume 25, Issue 3, Page(s) 393–403

    Abstract: Purpose: Literature regarding endogenous Cushing syndrome (CS) largely focuses on the challenges of diagnosis, subtyping, and treatment. The enigmatic phenomenon of glucocorticoid withdrawal syndrome (GWS), due to rapid reduction in cortisol exposure ... ...

    Abstract Purpose: Literature regarding endogenous Cushing syndrome (CS) largely focuses on the challenges of diagnosis, subtyping, and treatment. The enigmatic phenomenon of glucocorticoid withdrawal syndrome (GWS), due to rapid reduction in cortisol exposure following treatment of CS, is less commonly discussed but also difficult to manage. We highlight the clinical approach to navigating patients from GWS and adrenal insufficiency to full hypothalamic-pituitary-adrenal (HPA) axis recovery.
    Methods: We review the literature on the pathogenesis of GWS and its clinical presentation. We provide strategies for glucocorticoid dosing and tapering, HPA axis testing, as well as pharmacotherapy and ancillary treatments for GWS symptom management.
    Results: GWS can be difficult to differentiate from adrenal insufficiency and CS recurrence, which complicates glucocorticoid dosing and tapering regimens. Monitoring for HPA axis recovery requires both clinical and biochemical assessments. The most important intervention is reassurance to patients that GWS symptoms portend a favorable prognosis of sustained remission from CS, and GWS typically resolves as the HPA axis recovers. GWS also occurs during medical management of CS, and gradual dose titration based primarily on symptoms is essential to maintain adherence and to eventually achieve disease control. Myopathy and neurocognitive dysfunction can be chronic complications of CS that do not completely recover.
    Conclusions: Due to limited data, no guidelines have been developed for management of GWS. Nevertheless, this article provides overarching themes derived from published literature plus expert opinion and experience. Future studies are needed to better understand the pathophysiology of GWS to guide more targeted and optimal treatments.
    MeSH term(s) Adrenal Insufficiency/diagnosis ; Cushing Syndrome/diagnosis ; Glucocorticoids/therapeutic use ; Humans ; Hydrocortisone ; Hypothalamo-Hypophyseal System ; Pituitary-Adrenal System
    Chemical Substances Glucocorticoids ; Hydrocortisone (WI4X0X7BPJ)
    Language English
    Publishing date 2022-04-26
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1385151-2
    ISSN 1573-7403 ; 1386-341X
    ISSN (online) 1573-7403
    ISSN 1386-341X
    DOI 10.1007/s11102-022-01218-y
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  4. Article: Alcohol-induced Cushing syndrome: report of eight cases and review of the literature.

    Surani, Asif / Carroll, Ty B / Javorsky, Bradley R / Raff, Hershel / Findling, James W

    Frontiers in endocrinology

    2023  Volume 14, Page(s) 1199091

    Abstract: Introduction: Alcohol-induced hypercortisolism (AIH) is underrecognized and may masquerade as neoplastic hypercortisolism [Cushing syndrome (CS)] obscuring its diagnosis.: Objective and methods: In order to characterize AIH, we performed a chart ... ...

    Abstract Introduction: Alcohol-induced hypercortisolism (AIH) is underrecognized and may masquerade as neoplastic hypercortisolism [Cushing syndrome (CS)] obscuring its diagnosis.
    Objective and methods: In order to characterize AIH, we performed a chart review of eight patients (4 males and 4 females; 2014-2022) referred for evaluation and treatment of neoplastic hypercortisolism - six for inferior petrosal sinus sampling, one due to persistent CS after unilateral adrenalectomy, and one for pituitary surgery for Cushing disease (CD). Five underwent dDAVP stimulation testing.
    Results: All eight patients had clinical features of hypercortisolism and plasma ACTH levels within or above the reference interval confirming hypothalamic-pituitary mediation. All had abnormal low-dose dexamethasone suppression test and increased late-night salivary cortisol. Only one had increased urine cortisol excretion. In contrast to CD, the 5 patients tested had blunted or absent ACTH and cortisol responses to desmopressin. Two had adrenal nodules and one had abnormal pituitary imaging. Most patients underreported their alcohol consumption and one denied alcohol use. Elevated blood phosphatidyl ethanol (PEth) was required in one patient to confirm excessive alcohol use. All patients had elevations of liver function tests (LFTs) with AST>ALT.
    Conclusion: AIH is an under-appreciated, reversible cause of non-neoplastic hypercortisolism that is indistinguishable from neoplastic CS. Incidental pituitary and adrenal imaging abnormalities as well as under-reporting of alcohol consumption further confound the diagnosis. Measurement of PEth helps to confirm an alcohol use disorder. Elevations of LFTs (AST>ALT) and subnormal ACTH and cortisol responses to dDAVP help to distinguish AIH from neoplastic hypercortisolism.
    MeSH term(s) Male ; Female ; Humans ; Cushing Syndrome/complications ; Cushing Syndrome/diagnosis ; Hydrocortisone ; Deamino Arginine Vasopressin ; Pituitary ACTH Hypersecretion/complications ; Pituitary ACTH Hypersecretion/diagnosis ; Pituitary Diseases/complications ; Ethanol ; Adrenocorticotropic Hormone
    Chemical Substances Hydrocortisone (WI4X0X7BPJ) ; Deamino Arginine Vasopressin (ENR1LLB0FP) ; Ethanol (3K9958V90M) ; Adrenocorticotropic Hormone (9002-60-2)
    Language English
    Publishing date 2023-06-20
    Publishing country Switzerland
    Document type Review ; Case Reports ; Journal Article
    ZDB-ID 2592084-4
    ISSN 1664-2392
    ISSN 1664-2392
    DOI 10.3389/fendo.2023.1199091
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  5. Article: Important Management Considerations In Patients With Pituitary Disorders During The Time Of The Covid-19 Pandemic.

    Yuen, Kevin C J / Blevins, Lewis S / Findling, James W

    Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

    2021  Volume 26, Issue 8, Page(s) 915–922

    Abstract: Objective: In December 2019, a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused an outbreak of coronavirus disease 2019 (COVID-19) that resulted in a global pandemic with substantial morbidity and mortality. ... ...

    Abstract Objective: In December 2019, a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused an outbreak of coronavirus disease 2019 (COVID-19) that resulted in a global pandemic with substantial morbidity and mortality. Currently, there is no specific treatment or approved vaccine against COVID-19. The underlying associated comorbidity and diminished immune function of some pituitary patients (whether caused by the disease and its sequelae or treatment with excess glucocorticoids) increases their risk of contracting and developing complications from COVID-19 infection.
    Methods: A review of studies in PubMed and Google Scholar published between January 2020 to the time of writing (May 1, 2020) was conducted using the search terms 'pituitary,' 'coronavirus,' 'COVID-19', '2019-nCoV', 'diabetes mellitus', 'obesity', 'adrenal,' and 'endocrine.'
    Results: Older age and pre-existing obesity, hypertension, cardiovascular disease, and diabetes mellitus increase the risk of hospitalization and death in COVID-19 patients. Men tend to be more severely affected than women; fortunately, most men, particularly of younger age, survive the infection. In addition to general comorbidities that may apply to many pituitary patients, they are also susceptible due to the following pituitary disorder-specific features: hypercortisolemia and adrenal suppression with Cushing disease, adrenal insufficiency and diabetes insipidus with hypopituitarism, and sleep-apnea syndrome and chest wall deformity with acromegaly.
    Conclusion: This review aims to focus on the impact of COVID-19 in patients with pituitary disorders. As most countries are implementing mobility restrictions, we also discuss how this pandemic has affected patient attitudes and impacted our decision-making on management recommendations for these patients.
    Abbreviations: ACE = angiotensin-converting enzyme; AI = adrenal insufficiency; ARB = angiotensin receptor blocker; ARDS = acute respiratory disease syndrome; COVID-19 = coronavirus disease 2019; CPAP = continuous positive airway pressure; DI = diabetes insipidus; DM = diabetes mellitus; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.
    MeSH term(s) Aged ; Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; COVID-19 ; COVID-19 Vaccines ; Female ; Humans ; Male ; Pandemics ; Pituitary Diseases/epidemiology ; SARS-CoV-2
    Chemical Substances Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; COVID-19 Vaccines
    Language English
    Publishing date 2021-01-20
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1473503-9
    ISSN 1530-891X
    ISSN 1530-891X
    DOI 10.4158/EP-2020-0308
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 5034: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)
    Zs.MO 508: Show issues

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  6. Article ; Online: Differentiation of pathologic/neoplastic hypercortisolism (Cushing syndrome) from physiologic/non-neoplastic hypercortisolism (formerly known as Pseudo-Cushing syndrome): response to Letter to the Editor.

    Findling, James W / Raff, Hershel

    European journal of endocrinology

    2018  Volume 178, Issue 3, Page(s) L3

    MeSH term(s) Addison Disease ; Cushing Syndrome ; Humans ; Hydrocortisone
    Chemical Substances Hydrocortisone (WI4X0X7BPJ)
    Language English
    Publishing date 2018
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 1183856-5
    ISSN 1479-683X ; 0804-4643
    ISSN (online) 1479-683X
    ISSN 0804-4643
    DOI 10.1530/EJE-17-1034
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  7. Article: Evolution, global warming, smart phones, and late-night salivary cortisol.

    Findling, James W

    Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

    2014  Volume 21, Issue 2, Page(s) 205–207

    MeSH term(s) Female ; Humans ; Hydrocortisone/analysis ; Male ; Pituitary ACTH Hypersecretion/diagnosis ; Saliva/chemistry
    Chemical Substances Hydrocortisone (WI4X0X7BPJ)
    Language English
    Publishing date 2014-10-08
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 1473503-9
    ISSN 1530-891X
    ISSN 1530-891X
    DOI 10.4158/EP14451.CO
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  8. Article ; Online: DIAGNOSIS OF ENDOCRINE DISEASE: Differentiation of pathologic/neoplastic hypercortisolism (Cushing's syndrome) from physiologic/non-neoplastic hypercortisolism (formerly known as pseudo-Cushing's syndrome).

    Findling, James W / Raff, Hershel

    European journal of endocrinology

    2017  Volume 176, Issue 5, Page(s) R205–R216

    Abstract: Endogenous hypercortisolism (Cushing's syndrome) usually implies the presence of a pathologic condition caused by either an ACTH-secreting neoplasm or autonomous cortisol secretion from a benign or malignant adrenal neoplasm. However, sustained or ... ...

    Abstract Endogenous hypercortisolism (Cushing's syndrome) usually implies the presence of a pathologic condition caused by either an ACTH-secreting neoplasm or autonomous cortisol secretion from a benign or malignant adrenal neoplasm. However, sustained or intermittent hypercortisolism may also accompany many medical disorders that stimulate physiologic/non-neoplastic activation of the HPA axis (formerly known as pseudo-Cushing's syndrome); these two entities may share indistinguishable clinical and biochemical features. A thorough history and physical examination is often the best (and sometimes only) way to exclude pathologic/neoplastic hypercortisolism. The presence of alcoholism, renal failure, poorly controlled diabetes and severe neuropsychiatric disorders should always raise suspicion that the presence of hypercortisolism may be related to physiologic/non-neoplastic Cushing's syndrome. As late-night salivary cortisol and low-dose dexamethasone suppression have good sensitivity and negative predictive value, normal studies exclude Cushing's syndrome of any form. However, these tests have imperfect specificity and additional testing over time with clinical follow-up is often needed. When there is persistent diagnostic uncertainty, secondary tests such as the DDAVP stimulation test and the dexamethasone-CRH test may provide evidence for the presence or absence of an ACTH-secreting tumor. This review will define and characterize the numerous causes of physiologic/non-neoplastic hypercortisolism and provide a rational clinical and biochemical approach to distinguish it from pathologic/neoplastic hypercortisolism (true Cushing's syndrome).
    MeSH term(s) Animals ; Cushing Syndrome/blood ; Cushing Syndrome/diagnosis ; Cushing Syndrome/pathology ; Endocrine System Diseases/blood ; Endocrine System Diseases/diagnosis ; Endocrine System Diseases/pathology ; Humans ; Hydrocortisone/blood
    Chemical Substances Hydrocortisone (WI4X0X7BPJ)
    Language English
    Publishing date 2017-02-08
    Publishing country England
    Document type Comparative Study ; Journal Article ; Review
    ZDB-ID 1183856-5
    ISSN 1479-683X ; 0804-4643
    ISSN (online) 1479-683X
    ISSN 0804-4643
    DOI 10.1530/EJE-16-0946
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  9. Article ; Online: A commentary on Diagnosing Cushing's disease in the context of renal failure.

    Raff, Hershel / Cohen, Eric P / Findling, James W

    European journal of endocrinology

    2019  Volume 181, Issue 4, Page(s) C9–C11

    Abstract: The diagnosis of endogenous hypercortisolism (Cushing's syndrome) is extremely challenging. Chronic kidney disease (CKD) increases the activity of the hypothalamic-pituitary-adrenal axis making the diagnosis of Cushing's syndrome even more challenging. ... ...

    Abstract The diagnosis of endogenous hypercortisolism (Cushing's syndrome) is extremely challenging. Chronic kidney disease (CKD) increases the activity of the hypothalamic-pituitary-adrenal axis making the diagnosis of Cushing's syndrome even more challenging. This is particularly so since urine free cortisol (UFC) testing is not useful in CKD. The case report by Stroud et al. in this issue of the European Journal of Endocrinology highlights this problem by finding normal UFC in a patient with pituitary ACTH-dependent Cushing's syndrome. Elevated late-night salivary cortisol (LNSC) testing was diagnostic and pituitary adenomectomy was curative. LNSC measurement is the diagnostic test of choice in patients with suspected Cushing's syndrome, particularly in the presence of CKD..
    Language English
    Publishing date 2019-07-23
    Publishing country England
    Document type Journal Article
    ZDB-ID 1183856-5
    ISSN 1479-683X ; 0804-4643
    ISSN (online) 1479-683X
    ISSN 0804-4643
    DOI 10.1530/EJE-19-0560
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  10. Article ; Online: Excellence in the treatment of patients with pituitary tumors.

    Molitch, Mark E / Findling, James W / Clemmons, David R

    Pituitary

    2017  

    Language English
    Publishing date 2017-11-09
    Publishing country United States
    Document type Letter
    ZDB-ID 1385151-2
    ISSN 1573-7403 ; 1386-341X
    ISSN (online) 1573-7403
    ISSN 1386-341X
    DOI 10.1007/s11102-017-0848-0
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