Cushing's disease: pathobiology, diagnosis, and management
Open accessAbstract
Cushing's disease (CD) is the result of excess secretion of adrenocorticotropic hormone (ACTH) by a benign monoclonal pituitary adenoma. The excessive secretion of ACTH stimulates secretion of cortisol by the adrenal glands, resulting in supraphysiological levels of circulating cortisol. The pathophysiological levels of cortisol are associated with hypertension, diabetes, obesity, and early death. Successful resection of the CD-associated ACTH-secreting pituitary adenoma is the treatment of choice and results in immediate biochemical remission with preservation of pituitary function. Accurate and early identification of CD is critical for effective surgical management and optimal prognosis. The authors review the current pathophysiological principles, diagnostic methods, and management of CD.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Cushing disease is the most common cause of ACTH-dependent CS, accounting for approximately 80% of cases.
“Cushing disease, the most common cause of ACTH-dependent CS accounting for approximately 80% of cases, occurs when a pituitary adenoma secretes ACTH, which in turn stimulates supraphysiologic secretion of cortisol from the adrenal glands (2, 4, 5, 73).”
From Approach to the Patient: Diagnosis of Cushing Syndrome (2022) · cites this paper as [73]
Cushing disease occurs when a pituitary adenoma secretes ACTH, which stimulates supraphysiologic secretion of cortisol from the adrenal glands.
“Cushing disease, the most common cause of ACTH-dependent CS accounting for approximately 80% of cases, occurs when a pituitary adenoma secretes ACTH, which in turn stimulates supraphysiologic secretion of cortisol from the adrenal glands (2, 4, 5, 73).”
From Approach to the Patient: Diagnosis of Cushing Syndrome (2022) · cites this paper as [73]
Cites
The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline.
Nieman, L. K., Biller, B. M. K., Findling, J. W., Newell-Price, J., Savage, M. O., Stewart, P. M., & Montori, V. M. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-0125 · Cited by 2,718 · cited 2× · see citing works
“72 surgical treatment selective adenomectomy Successful adenomectomy eradicates the ACTH-secreting adenoma and immediately eliminates excess cortisol production while maintaining normal pituitary function (Fig.”
BackgroundSelf-citationVALE, W., VAUGHAN, J., SMITH, M., & YAMAMOTO, G. (1983) · Endocrinology · doi:10.1210/endo-113-3-1121 · Cited by 563 · cited 1× · see citing works
“After the isolation, sequencing, and synthesis of CRH by Vale and colleagues in 1983, 106 CRH stimulation was introduced as a diagnostic test for the differential diagnosis of ACTH-dependent causes of CS (Fig.”
MethodFleseriu, M., Biller, B. M. K., Findling, J. W., Molitch, M. E., Schteingart, D. E., Gross, C., on behalf of the SEISMIC Study Investigators, The SEISMIC Study Investigators include, Auchus, R., Bailey, T., et al. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-3350 · Cited by 479 · see citing works
Cushing's syndrome in children and adolescents. Presentation, diagnosis, and therapy.
Magiakou, M. A., Mastorakos, G., Oldfield, E. H., Gomez, M. T., Doppman, J. L., Cutler, G. B., Nieman, L. K., & Chrousos, G. P. (1994) · New England Journal of Medicine · doi:10.1056/nejm199409083311002 · Cited by 430 · see citing works
Self-citationKetoconazole in Cushing's disease: is it worth a try?
Castinetti, F., Guignat, L., Giraud, P., Muller, M., Kamenicky, P., Drui, D., Caron, P., Luca, F., Donadille, B., Vantyghem, M. C., et al. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-3628 · Cited by 285 · see citing works
Andela, C. D., van Haalen, F. M., Ragnarsson, O., Papakokkinou, E., Johannsson, G., Santos, A., Webb, S. M., Biermasz, N. R., van der Wee, N. J. A., & Pereira, A. M. (2015) · European Journal of Endocrinology · doi:10.1530/eje-14-1101 · Cited by 164 · see citing works
Outcomes of proton therapy for patients with functional pituitary adenomas
Wattson, D. A., Tanguturi, S. K., Spiegel, D. Y., Niemierko, A., Biller, B. M. K., Nachtigall, L. B., Bussière, M. R., Swearingen, B., Chapman, P. H., Loeffler, J. S., et al. (2014) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/j.ijrobp.2014.06.068 · Cited by 125 · see citing works
Hameed, N., Yedinak, C. G., Brzana, J., Gultekin, S. H., Coppa, N. D., Dogan, A., Delashaw, J. B., & Fleseriu, M. (2013) · Pituitary · doi:10.1007/s11102-012-0455-z · Cited by 102 · see citing works
Mortality in Cushing's syndrome: data from 386 patients from a single tertiary referral center
Yaneva, M., Kalinov, K., & Zacharieva, S. (2013) · European Journal of Endocrinology · doi:10.1530/eje-13-0320 · Cited by 93 · see citing works
Diagnosis and complications of Cushing’s disease: gender-related differences
Zilio, M., Barbot, M., Ceccato, F., Camozzi, V., Bilora, F., Casonato, A., Frigo, A. C., Albiger, N., Daidone, V., Mazzai, L., et al. (2014) · Clinical Endocrinology · doi:10.1111/cen.12299 · Cited by 93 · see citing works
Carrasco, C. A., Coste, J., Guignat, L., Groussin, L., Dugué, M. A., Gaillard, S., Bertagna, X., & Bertherat, J. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-1171 · Cited by 83 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Reincke, M., & Fleseriu, M. (2023) · JAMA · doi:10.1001/jama.2023.11305 · Cited by 273 · see citing works
Non-invasive Diagnostic Strategy in ACTH-dependent Cushing’s Syndrome
Frete, C., Corcuff, J.-B., Kuhn, E., Salenave, S., Gaye, D., Young, J., Chanson, P., & Tabarin, A. (2020) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaa409 · Cited by 110 · see citing works
Approach to the Patient: Diagnosis of Cushing Syndrome
Savas, M., Mehta, S., Agrawal, N., van Rossum, E. F. C., & Feelders, R. A. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac492 · Cited by 91 · see citing works
“Cushing disease, the most common cause of ACTH-dependent CS accounting for approximately 80% of cases, occurs when a pituitary adenoma secretes ACTH, which in turn stimulates supraphysiologic secretion of cortisol from the adrenal glands (2, 4, 5, 73).”
BackgroundNitrile-containing pharmaceuticals: target, mechanism of action, and their SAR studies
Wang, X., Wang, Y. E., Li, X., Yu, Z., Song, C. F., & Du, Y. (2021) · RSC Medicinal Chemistry · doi:10.1039/d1md00131k · Cited by 211 · see citing works
Delayed Complications After Transsphenoidal Surgery for Pituitary Adenomas.
Alzhrani, G., Sivakumar, W., Park, M., Taussky, P., & Couldwell, W. (2018) · World Neurosurgery · doi:10.1016/j.wneu.2017.09.192 · Cited by 73
Nishioka, H., & Yamada, S. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8111951 · Cited by 65 · see citing works
“For the latter problem, proper placement of the catheter tips can be routinely confirmed by retrograde venography of the cavernous and inferior petrosal sinuses [92].”
BackgroundInfluentialLiu, Y.-F., Liu, X.-H., Hong, X., Liu, P.-H., Bao, X., Yao, Y., Xing, B., Li, Y.-S., Huang, Y., Zhu, H., et al. (2019) · Neuroendocrinology · doi:10.1159/000496753 · Cited by 63 · see citing works
Tabarin, A., Assié, G., Barat, P., Bonnet, F., Bonneville, J. F., Borson-Chazot, F., Bouligand, J., Boulin, A., Brue, T., Caron, P., et al. (2022) · Annales d Endocrinologie · doi:10.1016/j.ando.2022.02.001 · Cited by 59 · see citing works
An individualized approach to the management of Cushing disease
Fleseriu, M., Varlamov, E., Hinojosa-Amaya, J. M., Langlois, F., & Melmed, S. (2023) · Nature Reviews Endocrinology · doi:10.1038/s41574-023-00868-7 · Cited by 59 · see citing works
Cebula, H., Baussart, B., Villa, C., Assié, G., Boulin, A., Foubert, L., Aldéa, S., Bennis, S., Bernier, M., Proust, F., et al. (2017) · Acta Neurochirurgica · doi:10.1007/s00701-017-3140-1 · Cited by 57 · see citing works
“The inclusion criteria were: (1) Cushingoid symptoms; (2) endoc r i no l og i c a l con f i rma t i on o f endogenous hypercortisolism and a dynamic test to confirm CD [2, 15, 19, 20]; (3) preoperative pituitary MRI; (4) TEE procedures performed by the same neurosurgeon (S.”
BackgroundMethodFountas, A., Lavrentaki, A., Subramanian, A., Toulis, K. A., Nirantharakumar, K., & Karavitaki, N. (2018) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2018-01956 · Cited by 57 · see citing works
Earlier post-operative hypocortisolemia may predict durable remission from Cushing’s Disease
Ironside, N., Chatain, G., Asuzu, D. T., Benzo, S., Lodish, M., Sharma, S. T., Nieman, L., Stratakis, C., Lonser, R., & Chittiboina, P. (2018) · European Journal of Endocrinology · doi:10.1530/eje-17-0873 · Cited by 42 · see citing works
Self-citationUsefulness of 68Ga-Pentixafor PET/CT on Diagnosis and Management of Cushing Syndrome
Ding, J., Tong, A., Hacker, M., Feng, M., Huo, L., & Li, X. (2022) · Clinical Nuclear Medicine · doi:10.1097/rlu.0000000000004244 · Cited by 41 · see citing works
The molecular etiology and treatment of glucocorticoid-induced osteoporosis
Peng, C.-H., Lin, W.-Y., Yeh, K.-T., Chen, I.-H., Wu, W.-T., & Lin, M. (2021) · Tzu-Chi Medical Journal · doi:10.4103/tcmj.tcmj_233_20 · Cited by 41 · see citing works
“Cushing’s disease, causing an elevation of serum level of endogenous glucocorticoids, is correlated with osteoporosis [28-30].”
BackgroundSurgical outcomes in patients with Cushing’s disease: the Cleveland clinic experience
Johnston, P. C., Kennedy, L., Hamrahian, A. H., Sandouk, Z., Bena, J., Hatipoğlu, B., & Weil, R. J. (2017) · Pituitary · doi:10.1007/s11102-017-0802-1 · Cited by 44 · see citing works
Update on medical treatment for Cushing’s disease
Cuevas-Ramos, D., Lim, D., & Fleseriu, M. (2016) · Clinical Diabetes and Endocrinology · doi:10.1186/s40842-016-0033-9 · Cited by 40 · see citing works
“ACTH, in turn, stimulates melanocortin type 2 receptor (MC2R) at the adrenal cortex and increases cortisol synthesis [4, 5].”
BackgroundDiagnostic workup of Cushing’s syndrome
Balomenaki, M., Margaritopoulos, D., Vassiliadi, D. A., & Tsagarakis, S. (2022) · Journal of Neuroendocrinology · doi:10.1111/jne.13111 · Cited by 41 · see citing works
Mayberg, M., Reintjes, S., Patel, A., Moloney, K. J., Mercado, J. U., Carlson, A., Scanlan, J., & Broyles, F. (2017) · Journal of Neurosurgery · doi:10.3171/2017.6.jns17635 · Cited by 37 · see citing works
Kannankeril, J., Carroll, T., Findling, J. W., Javorsky, B., Gunsolus, I. L., Phillips, J., & Raff, H. (2020) · Journal of the Endocrine Society · doi:10.1210/jendso/bvaa107 · Cited by 36 · see citing works
“Neoplastic hypercortisolism is often responsible for cardiometabolic problems, including obesity, diabetes, hypertension, and low bone density, as well as significant neurocognitive and neuropsychiatric challenges [1-16].”
BackgroundBerkmann, S., Roethlisberger, M., Mueller, B., Christ-Crain, M., Mariani, L., Nitzsche, E., & Juengling, F. (2021) · Pituitary · doi:10.1007/s11102-021-01160-5 · Cited by 34
Asuzu, D. T., Chatain, G. P., Hayes, C. P., Benzo, S., McGlotten, R., Keil, M. F., Beri, A., Sharma, S. T., Nieman, L. K., Lodish, M. B., et al. (2017) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2016-3908 · Cited by 41 · see citing works
Self-citationCushing's Disease: Lessons Learned From 1500 Cases.
Oldfield, E. (2017) · Neurosurgery · doi:10.1093/neuros/nyx378 · Cited by 31
Self-citationAndereggen, L., Gralla, J., Schroth, G., Mordasini, P., Andres, R., Widmer, H., Luedi, M., Kellner, F., Beck, J., Mariani, L., et al. (2019) · Journal of neuroradiology. Journal de neuroradiologie · doi:10.1016/j.neurad.2019.05.004 · Cited by 29 · see citing works
Zoli, M., Staartjes, V. E., Guaraldi, F., Friso, F., Rustici, A., Asioli, S., Sollini, G., Pasquini, E., Regli, L., Serra, C., et al. (2020) · Neurosurgical FOCUS · doi:10.3171/2020.3.focus2060 · Cited by 39 · see citing works
Shepard, M. J., Mehta, G. U., Xu, Z.-Y., Kano, H., Sisterson, N. D., Su, Y.-H., Kršek, M., Nabeel, A., El-Shehaby, A., Kareem, K. A., et al. (2018) · World Neurosurgery · doi:10.1016/j.wneu.2018.05.067 · Cited by 27 · see citing works
Magnocellular vasopressin and the mechanism of “Glucocorticoid escape”
Antoni, F. A. (2019) · Frontiers in Endocrinology · doi:10.3389/fendo.2019.00422 · Cited by 26 · see citing works
“The classic clinical examples of persistent glucocorticoid non-suppression are Cushing’s disease (72) and melancholic depression (12).”
BackgroundPituitary adenomas evade apoptosis via noxa deregulation in Cushing’s disease
Asuzu, D. T., Alvarez, R., Fletcher, P., Mandal, D., Johnson, K. R., Wu, W.-W., Elkahloun, A., Clavijo, P. E., Allen, C. T., Maric, D., et al. (2022) · Cell Reports · doi:10.1016/j.celrep.2022.111223 · Cited by 23 · see citing works
“0 mg/24H forR18 year-olds) or low-dose dexamethasone suppression testing (1mg overnight or 2mg over 48 h) (Lonser et al., 2017; Nieman et al., 2008).”
Self-citationPigmented Lesions of the Oral Mucosa
Stoopler, E. T., & Alawi, F. (2017) · Springer eBooks · doi:10.1007/978-3-319-28100-1_17-1
“pituitary pathology – usually an ACTH-secreting adenoma (Lonser et al. 2016).”
BackgroundInfluentialWang, F., Catalino, M., Bi, W., Dunn, I., Smith, T. R., Guo, Y., Hordejuk, D., Kaiser, U., Laws, E., & Min, L. (2020) · Journal of Clinical Endocrinology and Metabolism · doi:10.1210/clinem/dgaa773 · Cited by 21 · see citing works
COVID-19 in Cushing disease: experience of a single tertiary centre in Lombardy
Serban, A., Ferrante, E., Carosi, G., Indirli, R., Arosio, M., & Mantovani, G. (2020) · Journal of Endocrinological Investigation · doi:10.1007/s40618-020-01419-x · Cited by 21
Liu, Z., Zhang, X.-B., Wang, Z.-W., You, H., Li, M.-L., Feng, F., & Jin, Z.-Y. (2020) · Scientific Reports · doi:10.1038/s41598-020-71628-0 · Cited by 20 · see citing works
Cote, D. J., Iuliano, S. L., Catalino, M., & Laws, E. (2020) · Neurosurgical Focus · doi:10.3171/2020.3.focus2043 · Cited by 19 · see citing works
Outcomes of Pituitary Radiation for Cushing’s Disease
Ironside, N. T., Chen, C., Lee, C., Trifiletti, D. M., Vance, M. L., & Sheehan, J. P. (2018) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2018.01.002 · Cited by 26 · see citing works
Second-Line Tests in the Diagnosis of Adrenocorticotropic Hormone-Dependent Hypercortisolism
Pinelli, S., Barbot, M., Scaroni, C. M., & Ceccato, F. (2021) · Annals of Laboratory Medicine · doi:10.3343/alm.2021.41.6.521 · Cited by 23 · see citing works
“However, some cases of ectopic ACTH-producing tumors can respond to CRH, leading to false-positive results [15].”
BackgroundAhmed, S. M., Ahmed, S. F., Othman, S., Abdulla, B. A., Mohammed, S. H., Salih, A., & Kakamad, F. (2021) · Annals of Medicine and Surgery · doi:10.1016/j.amsu.2021.102978 · Cited by 18
Hou, B., Gao, L., Shi, L., Luo, Y., Guo, X.-P., Young, G., Qin, L., Zhu, H., Lu, L., Wang, Z., et al. (2020) · Journal of Neurosurgery · doi:10.3171/2019.10.jns191400 · Cited by 18 · see citing works
“19,22 In addition to the typical physical manifestations of central obesity and rounded face, CD causes cognitive impairment and memory deficits thought to be related to changes in brain structures rich in glucocorticoid (GC) receptors.”
BackgroundNadezhdina, E., Rebrova, O., Grigoriev, A., Ivaschenko, O., Azizyan, V. N., Mel'nichenko, G., & Dedov, I. (2019) · Pituitary · doi:10.1007/s11102-019-00985-5 · Cited by 18 · see citing works
Seki, Y., Morimoto, S., Saito, F., Takano, N., Kimura, S., Yamashita, K., Yoshida, N., Bokuda, K., Sasaki, N., Yatabe, M., et al. (2019) · Journal of Clinical Endocrinology and Metabolism · doi:10.1210/jc.2018-02268 · Cited by 17
Donofrio, C., Losa, M., Gemma, M., Giudice, L., Barzaghi, L., & Mortini, P. (2017) · Endocrine · doi:10.1007/s12020-016-1214-0 · Cited by 17 · see citing works
Cavaleri, D., Capogrosso, C., Guzzi, P., Bernasconi, G., Re, M., Misiak, B., Crocamo, C., Bartoli, F., & Carrà, G. (2023) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2023.106392 · Cited by 16 · see citing works
“Such pattern indicates a dysregulation of the cortisol-driven negative feedback inhibition on pituitary ACTH secretion, suggesting that FEP might be characterized by an ACTH-dependent hypercortisolemia in a Cushing ’ s disease-like manner (Lonser et al., 2017).”
Ferrière, A., & Tabarin, A. (2021) · La Presse Médicale · doi:10.1016/j.lpm.2021.104091 · Cited by 19 · see citing works
Osilodrostat: A Novel Steroidogenesis Inhibitor to Treat Cushing’s Disease
Dougherty, J., Desai, D., & Herrera, J. B. (2020) · The Annals of Pharmacotherapy · doi:10.1177/1060028020968808 · Cited by 15 · see citing works
TSP‐1 is downregulated and inversely correlates with miR‐449c expression in Cushing's disease
Ren, J., Gu, C.-W., Yang, Y., Xue, J., Sun, Y.-H., Jian, F.-F., Chen, D., Bian, L.-G., & Sun, Q.-F. (2019) · Journal of Cellular and Molecular Medicine · doi:10.1111/jcmm.14297 · Cited by 15 · see citing works
Crock, P., Lüdecke, D. K., Knappe, U. J., & Saeger, W. (2018) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem-2018-0262 · Cited by 17 · see citing works
Findlay, M., Rennert, R., Lucke-Wold, B., Couldwell, W., Evans, J. J., Collopy, S., Kim, W., Delery, W., Pacione, D., Kim, A., et al. (2024) · Neurosurgery · doi:10.1227/neu.0000000000003090 · Cited by 14 · see citing works
“Elec-trolyte abnormalities such as AVP-D ( fi t, 13% [25/193]; managing well, 8% [9/113], and mildly frail, 17% [2/12], P = .27) and hyponatremia ( fi t, 6.2% [12/193]; managing well, 2.7% [3/113], and mildly frail, 0%; P = .39) were the most common complications, regardless of frailty status, and…”
InfluentialCai, Z., Qian, B., Pang, J., Tan, Z., Zhao, K., & Lei, T. (2022) · Current Medical Science · doi:10.1007/s11596-022-2568-6 · Cited by 14
Serban, A., Sala, E., Carosi, G., Sindaco, G. D., Giavoli, C., Locatelli, M., Arosio, M., Mantovani, G., & Ferrante, E. (2019) · Neuroendocrinology · doi:10.1159/000496846 · Cited by 14 · see citing works
Guinto, G., Guinto-Nishimura, G., Sangrador-Deitos, M., Uribe-Pacheco, R., Soto-Martinez, R., Gallardo, D., Guinto, P., Vargas, A., & Aréchiga, N. (2023) · Archives of Medical Research · doi:10.1016/j.arcmed.2023.102872 · Cited by 13
Cortical thickness abnormalities in long-term remitted Cushing’s disease
Bauduin, S., van der Pal, Z., Pereira, A. P., Meijer, O., Giltay, E., van der Wee, N. V. D., & van der Werff, S. V. D. (2020) · Translational Psychiatry · doi:10.1038/s41398-020-00980-6 · Cited by 13 · see citing works
Peripheral clock system circadian abnormalities in Cushing’s disease
Soares, V., Martins, C. S., Martinez, E., Araújo, L. D., Roa, S. L. R., Silva, L., Moreira, A., & de Castro, M. (2020) · Chronobiology International · doi:10.1080/07420528.2020.1758126 · Cited by 13 · see citing works
Guaraldi, F., Zoli, M., Asioli, S., Corona, G., Gori, D., Friso, F., Pasquini, E., Bacci, A., Sforza, A., & Mazzatenta, D. (2020) · Journal of Endocrinological Investigation · doi:10.1007/s40618-020-01225-5 · Cited by 13 · see citing works
Infantile Iatrogenic Cushing Syndrome due to Topical Steroids
Alkhuder, L., & Mawlawi, H. (2019) · Case Reports in Pediatrics · doi:10.1155/2019/2652961 · Cited by 13 · see citing works
“Cushing syndrome, an endocrinological disorder resulting from abnormally high plasma cortisol levels, is characterized by increased free plasma glucocorticoids level [1].”
BackgroundOvernight Corticosterone and Gene Expression in Mouse Hippocampus: Time Course during Resting Period
Jaszczyk, A., Stankiewicz, A. M., Gościk, J., Majewska, A., Jezierski, T. A., & Juszczak, G. R. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24032828 · Cited by 12 · see citing works
Mehta, G. U., Ding, D., Gupta, A., Kano, H., Sisterson, N. D., Martínez-Moreno, N., Kršek, M., Yang, H.-C., Lee, C.-C., Liščák, R., et al. (2018) · Journal of Neuro-Oncology · doi:10.1007/s11060-018-2817-5 · Cited by 12 · see citing works
Postoperative serum cortisol and Cushing disease recurrence in patients with corticotroph adenomas
Catalino, M. P., Moore, D. T., Ironside, N., Munoz, A. R., Coley, J., Jonas, R., Kearns, K., Min, L., Vance, M. L., Jane, J. A., et al. (2023) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgad347 · Cited by 11 · see citing works
Findlay, M. C., Tenhoeve, S., Alt, J. A., Rennert, R. C., Couldwell, W. T., Evans, J., Collopy, S., Kim, W. B., Delery, W., Pacione, D. R., et al. (2024) · Neurosurgery · doi:10.1227/neu.0000000000003042 · Cited by 12 · see citing works
Koh, C., Khan, D., Digpal, R., Horsfall, H. L., Ali, A. M. S., Baldeweg, S., Bouloux, P., Dorward, N., Drake, W., Evanson, J., et al. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.1090144 · Cited by 11 · see citing works
Pituitary surgery in Cushing’s disease: first line treatment and role of reoperation
Jones, P., & Swearingen, B. (2022) · Pituitary · doi:10.1007/s11102-022-01254-8 · Cited by 11 · see citing works
“Some data suggests that morning serum cortisol level less than 1 μg/dL predicts remission with a positive predictive value (PPV) of 96% [8], although other studies have shown that undetectable levels can still be seen in cases which later recur [9].”
BackgroundKim, M., Lee, H.-A., Cho, H.-M., Kang, S.-H., Lee, E., & Kim, I. (2017) · Korean Journal of Physiology and Pharmacology · doi:10.4196/kjpp.2018.22.1.23 · Cited by 11 · see citing works
“Cushing’s syndrome (CS) is caused by prolonged elevation of the levels of circulating cortisol [1].”
BackgroundMcKevitt, C., Gabriel, E., Marenco-Hillembrand, L., Otamendi-Lopez, A., Jeevaratnam, S., Almeida, J. P., Samson, S. L., & Chaichana, K. (2023) · Scientific Reports · doi:10.1038/s41598-023-42157-3 · Cited by 10 · see citing works
Liu, Z., Hou, B., You, H., Lu, L., Duan, L., Li, M.-L., Deng, K., Yao, Y., Zhu, H., & Feng, F. (2023) · European Radiology · doi:10.1007/s00330-023-09585-1 · Cited by 10
“Because of false negatives and false positives on cMRI and dMRI using 2D FSE sequence [7, 9, 10], a 3D SPGR sequence was introduced for identifying pituitary adenomas.”
BackgroundMethodde Eulate-Beramendi, S. Á., Ortega, A. C., Ollero, L., Niemann, L. K., Fernandez-Miranda, J. C., Bruneau, M., Berhouma, M., Cavallo, L. M., Cornelius, J. F., Daniel, R. T., et al. (2022) · Brain and Spine · doi:10.1016/j.bas.2022.100917 · Cited by 7 · see citing works
Development of 68Ga DOTA-CRH for PET/CT Imaging of ACTH-Dependent Cushing's Disease: Initial Study
Shukla, J., Vatsa, R., Walia, R., Chhabra, A., Rana, N., Singh, H., Kumar, R., & Mittal, B. (2021) · Cancer Biotherapy and Radiopharmaceuticals · doi:10.1089/cbr.2020.4686 · Cited by 10 · see citing works
“10–13 However, the method is invasive in nature and requires dedicated facilities and a high degree of perfection in addition to the involved cost.”
Flaus, A., Levigoureux, E., Haesebaert, J., Briet, C., Castinetti, F., Cristante, J., Drui, D., Germain, N., Maione, L., Illouz, F., et al. (2025) · Journal of Nuclear Medicine · doi:10.2967/jnumed.124.269392 · Cited by 9 · see citing works
“Details with regard to [ 11 C]MET synthesis, PET reconstruction and data correction, and MRI sequences are presented in the supplemental materials.”
InfluentialNie, D., Wang, D., Wang, Z., Fang, Q., Wang, H., Xie, W., Li, C., & Zhang, Y. (2024) · Microbiome · doi:10.1186/s40168-024-01939-1 · Cited by 11 · see citing works
“Cushing’s disease (CD) arises from pituitary neuroendocrine tumors (PitNETs) that release adrenal corticotropin (ACTH), prompting excessive cortisol production by the adrenal glands [1].”
BackgroundAbdali, A., Kalinin, P., Trunin, Y., Astafeva, L., Shkarubo, A., Chmutin, G., Chavda, V., Golanov, A., Abdali, B., Chernov, I., et al. (2021) · British Journal of Neurosurgery · doi:10.1080/02688697.2021.1921107 · Cited by 9
“The radiation dose to the optic chiasm should not exceed 8Gy, and, at the same time, the distance between lesion and optic chiasm should not be less than 3mm.(8) In contrast, fractionated stereotactic radiosurgery (FSRS) can be used for larger lesions or for lesions which are located in close proximity to critical str…”
BackgroundAndereggen, L., Gralla, J., & Christ, E. (2024) · Acta Neurochirurgica · doi:10.1007/s00701-024-06058-2 · Cited by 8
“Inferior petrosal sinus sampling (IPSS) is an established method to identify the correct source of ACTH-dependent Cushing’s syndrome (CS) in patients with inconclusive imaging [14, 20].”
Eisenhut, F., Schlaffer, S., Hock, S. W., Heynold, E., Kremenevski, N., Bluemcke, I., Buchfelder, M., Doerfler, A., & Schmidt, M. (2022) · Investigative Radiology · doi:10.1097/rli.0000000000000872 · Cited by 8
Gao, L., Liu, L., Shi, L., Luo, Y., Wang, Z., Guo, X., & Xing, B. (2020) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-020-09540-1 · Cited by 11 · see citing works
Intraoperative Predictor of Remission in Cushing Disease
Zachariah, M. A., Cua, S., Muhlestein, W., Otto, B. A., Carrau, R., Kirschner, L., Ghalib, L., Lonser, R., Hardesty, D., & Prevedello, D. (2022) · Operative Neurosurgery · doi:10.1227/ons.0000000000000560 · Cited by 7 · see citing works
Self-citationIdentification of a novel specific small-molecule melanocortin-2-receptor antagonist
Forfar, R. A. E., Hussain, M., Khurana, P., Cook, J. M., Lewis, S., Popat, D., Jackson, D. S., Mciver, E. G., Jerman, J., Taylor, D. L., et al. (2022) · Endocrine Connections · doi:10.1530/ec-22-0338 · Cited by 7 · see citing works
Recent advancements in the molecular biology of pituitary adenomas
Zheng, A. C., Wang, E., & Aghi, M. (2022) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2022.2082942 · Cited by 7 · see citing works
“These adenomas can affect both the pediatric and adult population with an equal distribution between sexes in pediatric cases but affecting females more than males 5:1 in adult cases [83].”
BackgroundBray, D. P., Rindler, R. S., Dawoud, R. A., Boucher, A. B., & Oyesiku, N. M. (2022) · Otolaryngologic Clinics of North America · doi:10.1016/j.otc.2021.12.006 · Cited by 7 · see citing works
Shi, X.-L., Du, T.-T., Zhu, D., Ma, D.-L., Dong, K., Peng, X., Huang, J., Lei, T., Yu, X., Chen, J., et al. (2021) · Endocrine · doi:10.1007/s12020-021-02891-y · Cited by 7 · see citing works
The role of reoperation after recurrence of Cushing’s disease
Cardinal, T. M., Zada, G., & Carmichael, J. D. (2021) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2021.101489 · Cited by 7 · see citing works
The Human Hypothalamus: Anatomy, Dysfunction and Disease Management
Uwaifo, G. (2021) · doi:10.1007/978-3-030-62187-2 · Cited by 7
“A relatively small number of neurons (~1500) located in the preoptic area (POA) and the arcuate nucleus (ARC) of the hypothalamus are required for the coordination of reproductive function via the hypothalamic- pituitary- gonadal (HPG) axis.”
BackgroundInfluentialWang, C., Sun, Y.-J., Yin, X., Feng, R.-Q., Feng, R.-Y., Xu, M., Liang, K., Zhao, R., Gu, G., Jiang, X.-W., et al. (2021) · Clinical Epigenetics · doi:10.1186/s13148-021-01205-3 · Cited by 6 · see citing works
“In non-pregnant patients with CS, adrenocorticotropic hormone (ACTH)-secreting pituitary tumors account for 60–70% of cases [2].”
BackgroundKara, M., Güdük, M., Samancı, Y., Yilmaz, M., Şengöz, M., & Peker, S. (2020) · Clinical neurology and neurosurgery (Dutch-Flemish ed. Print) · doi:10.1016/j.clineuro.2020.106151 · Cited by 6
Stalla, G. K., Ciato, D., & Dimopoulou, C. (2018) · Experimental and clinical endocrinology & diabetes · doi:10.1055/a-0664-7632 · Cited by 6 · see citing works
Gao, Y., Wang, M.-Q., Wu, Y., Deng, H., Xu, Y.-Y., Ren, Y., Wang, C., & Wang, W. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12041288 · Cited by 5 · see citing works
“Best biochemical remission for CD patients was a morning serum cortisol level less than 1 mg/dl on postoperative days 3, 4, or 5 [1].”
BackgroundPasireotide Treatment in Cushing?s Disease: A Single Tertiary Center's Experience
Şahin, S., KARİMOVA, G., Özcan, Ş. G., Durcan, E., Özkaya, H. M., & Kadıoğlu, P. (2021) · TURKISH JOURNAL OF MEDICAL SCIENCES · doi:10.3906/sag-2105-261 · Cited by 5 · see citing works
“Diabetes, cardiovascular events, immunosuppression, osteoporosis, and psychiatric disturbances are associated with morbidity in patients with CD [7].”
BackgroundPrasad, S. M. V. K., Muralidhar, M. N., Dinesh Yadav, D. M., Kondeti, S., & Kalashikam, R. R. (2020) · Steroids · doi:10.1016/j.steroids.2020.108653 · Cited by 8 · see citing works
Chen, S.-Y., Xu, S.-J., Lin, F., Zhang, X., Liu, F.-Q., Dong, M., Li, X.-G., & Ma, X.-Y. (2019) · Experimental and Therapeutic Medicine · doi:10.3892/etm.2019.8075 · Cited by 5
“5% (66/79), which is comparable to that of other studies (1,2).”
BackgroundResultInfluentialKoracevic, G. P., Stojkovic, M., Lović, D. B., Pavlović, M., Kostić, T. L., Kutlesic, M. S., Mićić, S., Koraćević, M., & Djordjević, M. (2018) · Current Vascular Pharmacology · doi:10.2174/1570161116666181005122339 · Cited by 7 · see citing works
Liu, Z., Hou, B., You, H., Lu, L., Duan, L., Li, M.-L., Fan, X., Deng, K., Yao, Y., Zhu, H., et al. (2023) · Journal of Magnetic Resonance Imaging · doi:10.1002/jmri.28975 · Cited by 4
“7,8 Images with 2-to 3-mm slice thickness may decrease the identi fi cation of ACTH-secreting pituitary adenomas because of partial volume effects.”
BackgroundEctopic sphenoidal ACTH-secreting adenoma revealed by 11C Methionine PET scan: case report
Lurquin, F., Constantinescu, S., Furnica, R., Duprez, T., Raftopoulos, C., Daoud, L., Lammens, M., & Maiter, D. (2023) · BMC Endocrine Disorders · doi:10.1186/s12902-023-01298-2 · Cited by 4
“In our patient, in spite of negative pituitary MR examination, the very high central/peripheral ACTH gradient at BIPSS (above 100) convinced us to perform exploratory pituitary surgery, initially targeted to the right side and thereafter to the left side, as advocated by recent surgical guidelines [5].”
MethodPatient reported outcomes and treatment satisfaction in patients with cushing syndrome
Rakovec, M., Zhu, W., Khalafallah, A. M., Salvatori, R., Hamrahian, A., Gallia, G., Ishii, M., London, N., Ramanathan, M., Rowan, N., et al. (2022) · Endocrine · doi:10.1007/s12020-022-03214-5 · Cited by 4 · see citing works
“Approximately 70–80% of endogenous CS cases are due to Cushing disease (CD), where an ACTH-secreting pituitary adenoma stimulates the production and secretion of cortisol from the adrenal glands [4].”
BackgroundAydin, B., Yıldırım, E., Erdogan, O., Arğa, K., Yilmaz, B., Bozkurt, S., Bayraklı, F., & Turanli, B. (2022) · Omics · doi:10.1089/omi.2021.0221 · Cited by 4 · see citing works
“Despite its high efficacy, mitotane is not suitable as monotherapy due to its long onset of action and its various potential side effects, including gastrointestinal, neurologic, metabolic, hepatic, hematologic, skin, and bladder toxicities (Lonser et al., 2017; Tritos and Biller, 2019).”
Malygina, A. A., Belaya, Z. E., Nikitin, A. G., Koshkin, P. A., Sitkin, I. I., Лапшина, А. М., Магомедовна, Х. П., Lutsenko, A. S., Аршалуйсовна, Т. Д., & Mel'nichenko, G. A. (2021) · Problems of Endocrinology · doi:10.14341/probl12817 · Cited by 4 · see citing works
Morning Serum Cortisol as a Predictor for the HPA Axis Recovery in Cushing’s Disease
Cui, Q., Liu, D., Xiang, B., Sun, Q., Fan, L., He, M., Wang, Y., Zhu, X., & Ye, H. (2021) · International Journal of Endocrinology · doi:10.1155/2021/4586229 · Cited by 3 · see citing works
Lewis, D. G., Roncaroli, F., Kearney, T., Coope, D. J., & Gnanalingham, K. K. (2021) · Neuroendocrinology · doi:10.1159/000516823 · Cited by 4 · see citing works
Zhou, Y.-Z., Li, C.-Z., Gao, H., & Zhang, Y.-Z. (2018) · World Neurosurgery · doi:10.1016/j.wneu.2018.02.181 · Cited by 4 · see citing works
Osilodrostat Safety Profile: Findings from Real-World Data in the FAERS Database
Ilie, I. R. P., Butucă, A., Homorodean, C., Dobrea, C. M., Morgovan, C., Frum, A., & Ghibu, S. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14103518 · Cited by 2 · see citing works
“Nevertheless, these findings offer valuable insights and a foundation for future, more comprehensive safety assessments.”
Nelson's Syndrome: A Narrative Review
Torres-Ríos, J. A., Romero-Luna, G., Meraz-Soto, J. M., Zavala-Romero, L., Maqueda, M. L. A., Rodríguez-Camacho, A., & Jiménez, S. M. (2023) · Cureus · doi:10.7759/cureus.39114 · Cited by 3 · see citing works
“In most cases, biochemical remission and immediately circulating cortisol control result from the procedure, and patients may have a good prognosis [1,2].”
BackgroundChen, W., Chen, L., Pei, L., Zeng, R., Wu, L., Wang, C., Li, Y., Xiao, H., & Cao, X. (2022) · Neuroendocrinology · doi:10.1159/000526167 · Cited by 3 · see citing works
Meier, M., Alomari, A. A., Feldkamp, J., Mann, W. A., Santen, R., Ewald, N., & Knappe, U. (2022) · Experimental and clinical endocrinology & diabetes · doi:10.1055/a-1909-1639 · Cited by 3 · see citing works
“Cushing’s disease is caused by prolonged exposure to supraphysio logical high levels of cortisol due to an ACTHproducing pituitary adenoma [1, 2].”
BackgroundPreoperative Workup for Patients with Pituitary Lesions.
White, A., de Andrade, E. J., Kshettry, V., Sindwani, R., & Recinos, P. (2022) · Otolaryngologic clinics of North America · doi:10.1016/j.otc.2021.12.001 · Cited by 3
Kang, K., Muralidharan, K., Knowlton, H., Hassan, K., Yekula, A., Misra, M., Swearingen, B., & Jones, P. (2021) · Journal of Endocrinological Investigation · doi:10.1007/s40618-021-01680-8 · Cited by 3 · see citing works
Management of thyrotoxicosis occurring after surgery for Cushing's disease: a case series.
Jiang, S., Yang, C., Feng, M., Yao, Y., Deng, K., Xing, B., Lu, L., Zhu, H., Wang, R.-Z., & Bao, X. (2021) · Gland surgery · doi:10.21037/gs-21-49 · Cited by 3 · see citing works
“The reported remission rates are between 68% and 98% (4).”
BackgroundLong Term Follow-up after Endoscopic Endonasal Approach for the Treatment of Cushing's Disease
Todeschini, A. B., dos Santos, A. R. L., Dolci, R., Lima, J., Scalissi, N., & Lazarini, P. (2018) · Skull Base · doi:10.1055/s-0038-1669956 · Cited by 3
- Authors
- Lonser, R. R., Nieman, L., & Oldfield, E. H.
- Affiliations
- The Ohio State University Wexner Medical Center (US)
- National Institutes of Health (US)
- University of Virginia Health System (US)
- Corresponding author
- Lonser, Russell R.
- Venue
- Journal of Neurosurgery
- Published
- 2017-02
- Volume
- 126
- Issue
- 2
- Pages
- 404-417
- ISSN
- 0022-3085 (ISSN-L)
- 1933-0693
- OpenAlex
- W2340359999
- Cited by
- 215
- References
- 0
- Citations by year
- 2026: 16 · 2025: 27 · 2024: 19 · 2023: 25 · 2022: 33 · 2021: 25 · 2020: 21 · 2019: 18 · 2018: 16 · 2017: 11 · 2016: 3
- FWCI
- 2.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of neurosurgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
- Keywords
- Cushing's disease, hypercortisolism, cortisol excess, hypertension, diabetes mellitus, obesity, pituitary surgery, biochemical remission, diagnosis, pathophysiology
- MeSH terms
- Humans, Pituitary ACTH Hypersecretion
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
