A physiologic approach to diagnosis of the Cushing syndrome.

Raff, Hershel; Findling, James W.

doi:10.7326/0003-4819-138-12-200306170-00010

Cited by 186Pituitary Gland Disorders and TreatmentsAdrenal Hormones and DisordersElectrolyte and hormonal disorders

A physiologic approach to diagnosis of the Cushing syndrome.

Raff, Hershel, Findling, James W.·2003·Annals of Internal Medicine

DOI 10.7326/0003-4819-138-12-200306170-00010

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Reviews17 June 2003A Physiologic Approach to Diagnosis of the Cushing SyndromeHershel Raff, PhD and James W. Findling, MDHershel Raff, PhDFrom St. Luke's Medical Center, Medical College of Wisconsin, Milwaukee, Wisconsin. and James W. Findling, MDFrom St. Luke's Medical Center, Medical College of Wisconsin, Milwaukee, Wisconsin.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-138-12-200306170-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Principles*GeneralObesityHypertensionMetabolicDiabetes mellitus or impaired glucose toleranceHyperlipidemiaNephrolithiasisPolyuriaSkinPlethoraHirsutismStriaeAcneBruisingMusculoskeletalOsteopenia or osteoporosisProximal myopathyNeuropsychiatricDepressionCognitive impairmentEmotional labilityEuphoriaPsychosisGonadal dysfunctionOligomenorrhea or amenorrheaImpotence, decreased libidoImmune suppression (susceptible to opportunistic infection)*Notice that many of the features of the Cushing syndrome resemble those of the metabolic syndrome (e.g., obesity, hypertension, impaired glucose tolerance, hyperlipidemia, hirsutism, acne, and gonadal dysfunction).Pathophysiologic PrinciplesThe hypothalamicpituitaryadrenal axisControl of adrenal function and growthHypothalamic control of pituitary functionGlucocortcoid-negative feedbackCircadian rhythmThe stress responsePosttranslational processing of proopiomelanocortin to adrenocorticotropic hormoneCortisol plasma binding, metabolism, and excretionGlucocorticoid action11-hydroxysteroid dehydrogenase type 1 and 11-hydroxysteroid dehydrogenase type 2The relationship among obesity, impaired glucose tolerance or diabetes, hypertension, and gonadal dysfunction was initially ...References1. 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In patients with baseline ACTH between 10 and 20 pg/ml, an ACTH peak below 30 pg/ml after CRH excludes ACTH-dependent subclinical hypercortisolism.
“In these patients, an ACTH peak below 30 pg/ml (6.6 pmol/liter) after CRH excludes the presence of an ACTH-dependent SH (76).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [76]

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The Ectopic Adrenocorticotropin Syndrome: Clinical Features, Diagnosis, Management, and Long-Term Follow-Up
Isidori, A. M., Kaltsas, G., Pozza, C., Frajese, V., Newell-Price, J. D. C., Reznek, R. H., Jenkins, P. J., Monson, J. P., Grossman, A. B., & BESSER, G. M. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-1542 · Cited by 519 · see citing works
AME Position Statement on adrenal incidentaloma
Terzolo, M., Stigliano, A., Chiodini, I., Loli, P., Furlani, L., Arnaldi, G., Reimondo, G., Pia, A., Toscano, V., Zini, M., et al. (2011) · European Journal of Endocrinology · doi:10.1530/eje-10-1147 · Cited by 519 · see citing works
American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient
Mechanick, J. I., Kushner, R. F., Sugerman, H. J., González-Campoy, J. M., Collazo–Clavell, M. L., Guven, S., Spitz, A. F., Apovian, C. M., Livingston, E. H., Brolin, R. E., et al. (2008) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2008.08.009 · Cited by 372 · see citing works
AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, THE OBESITY SOCIETY, AND AMERICAN SOCIETY FOR METABOLIC & BARIATRIC SURGERY MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE PERIOPERATIVE NUTRITIONAL, METABOLIC, AND NONSURGICAL SUPPORT OF THE BARIATRIC SURGERY PATIENT
Mechanick, J. I., Kushner, R. F., Sugerman, H. J., González-Campoy, J. M., Collazo–Clavell, M. L., Spitz, A. F., Apovian, C. M., Livingston, E. H., Brolin, R. E., Sarwer, D. B., et al. (2009) · Obesity · doi:10.1038/oby.2009.28 · Cited by 338 · see citing works
Cushing’s Syndrome: important issues in diagnosis and management
Findling, J. W., & Raff, H. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2006-0997 · Cited by 294 · see citing works
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Diagnosis and Treatment of Subclinical Hypercortisolism
Chiodini, I. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2010-2722 · Cited by 279 · see citing works
Aptamer-based lateral flow assay for point of care cortisol detection in sweat
Dalirirad, S., & Steckl, A. J. (2018) · Sensors and Actuators B Chemical · doi:10.1016/j.snb.2018.11.161 · Cited by 260 · see citing works
Accuracy of Diagnostic Tests for Cushing’s Syndrome: A Systematic Review and Metaanalyses
Elamin, M. B., Murad, M. H., Mullan, R., Erickson, D., Harris, K., Nadeem, S., Ennis, R., Erwin, P. J., & Montori, V. M. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-0139 · Cited by 222 · see citing works
Management of Cushing disease
Tritos, N. A., Biller, B. M. K., & Swearingen, B. (2011) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2011.12 · Cited by 212 · see citing works
American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient
Mechanick, J. I., Kushner, R. F., Sugerman, H. J., González-Campoy, J. M., Collazo–Clavell, M. L., Guven, S., Spitz, A. F., Apovian, C. M., Livingston, E. H., Brolin, R. E., et al. (2008) · Endocrine Practice · doi:10.4158/ep.14.s1.1 · Cited by 193 · see citing works
Association of subclinical hypercortisolism with type 2 diabetes mellitus: a case-control study in hospitalized patients
Chiodini, I., Torlontano, M., Scillitani, A., Arosio, M., Bacci, S., Di Lembo, S., Epaminonda, P., Augello, G., Enrini, R., Ambrosi, B., et al. (2005) · European Journal of Endocrinology · doi:10.1530/eje.1.02045 · Cited by 190 · see citing works
Utility of salivary cortisol measurements in Cushing's syndrome and adrenal insufficiency
Raff, H. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-1166 · Cited by 186 · see citing works
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Detection of Cortisol in Saliva with a Flow-Filtered, Portable Surface Plasmon Resonance Biosensor System
Stevens, R. C., Soelberg, S. D., Near, S., & Furlong, C. E. (2008) · Analytical Chemistry · doi:10.1021/ac800892h · Cited by 179 · see citing works
Ectopic ACTH syndrome
Isidori, A. M., & Lenzi, A. (2007) · Arquivos Brasileiros de Endocrinologia & Metabologia · doi:10.1590/s0004-27302007000800007 · Cited by 179 · see citing works
Reproducibility of nighttime salivary cortisol and its use in the diagnosis of hypercortisolism compared with urinary free cortisol and overnight dexamethasone suppression test.
Viardot, A., Huber, P., Puder, J. J., Zulewski, H., Keller, U., & Müller, B. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-2264 · Cited by 172 · see citing works
The low-dose dexamethasone suppression test: a reevaluation in patients with Cushing's syndrome
Findling, J. W., Raff, H., & Aron, D. C. (2004) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-030207 · Cited by 165 · see citing works
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Subclinical hypercortisolism among outpatients referred for osteoporosis.
Chiodini, I., Mascia, M. L., Muscarella, S., Battista, C., Minisola, S., Arosio, M., Santini, S. A., Guglielmi, G., Carnevale, V., & Scillitani, A. (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-147-8-200710160-00006 · Cited by 162 · see citing works
Long-Term Natural Course of Pituitary Tumors in Patients With MEN1: Results From the DutchMEN1 Study Group (DMSG)
de Laat, J. M., Dekkers, O. M., Pieterman, C. R. C., Kluijfhout, W. P., Hermus, A. R., Pereira, A. M., van der Horst‐Schrivers, A. N. A., Drent, M. L., Bisschop, P. H. L. T., Havekes, B., et al. (2015) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2015-2015 · Cited by 159 · see citing works
Aptamer-Based Lateral Flow Biosensor for Rapid Detection of Salivary Cortisol
Dalirirad, S., Han, D., & Steckl, A. J. (2020) · ACS Omega · doi:10.1021/acsomega.0c03223 · Cited by 153 · see citing works
Nano Gold-Doped Molecularly Imprinted Electrochemical Sensor for Rapid and Ultrasensitive Cortisol DetectionPreprint
Yeasmin, S., Wu, B., Liu, Y., Ullah, A., & Cheng, L.-J. “. (2022) · SSRN Electronic Journal · doi:10.1016/j.bios.2022.114142 · Cited by 148 · see citing works
Physiological basis for the etiology, diagnosis, and treatment of adrenal disorders: Cushing’s syndrome, adrenal insufficiency, and congenital adrenal hyperplasia
Raff, H., Sharma, S. T., & Nieman, L. K. (2014) · Comprehensive Physiology · doi:10.1002/cphy.c130035 · Cited by 141 · see citing works
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Cushing’s syndrome: from physiological principles to diagnosis and clinical care
Raff, H., & Carroll, T. (2015) · The Journal of Physiology · doi:10.1113/jphysiol.2014.282871 · Cited by 137 · see citing works
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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, J. W., & Raff, H. (2017) · European Journal of Endocrinology · doi:10.1530/eje-16-0946 · Cited by 134 · see citing works
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Subclinical Cushing’s syndrome: definition and management
Terzolo, M., Pia, A., & Reimondo, G. (2011) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2011.04253.x · Cited by 129 · see citing works
Screening and diagnosis of Cushing’s syndrome
Findling, J. W., & Raff, H. (2005) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2005.02.001 · Cited by 127 · see citing works
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The Physiologic Effects of Pain on the Endocrine System
Tennant, F. S. (2013) · Pain and Therapy · doi:10.1007/s40122-013-0015-x · Cited by 130 · see citing works
Identification of Patients with Cushing’s Disease with Negative Pituitary Adrenocorticotropin Gradients during Inferior Petrosal Sinus Sampling: Prolactin as an Index of Pituitary Venous Effluent
Findling, J. W., Kehoe, M. E., & Raff, H. (2004) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-1378 · Cited by 125 · see citing works
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Cushing's syndrome
Shibli-Rahhal, A. A., Beek, M. J. V., & Schlechte, J. (2006) · Clinics in Dermatology · doi:10.1016/j.clindermatol.2006.04.012 · Cited by 123 · see citing works
The Clinical Conundrum of Corticotropin‐independent Autonomous Cortisol Secretion in Patients with Bilateral Adrenal Masses
Young, W. F., du Plessis, H., Thompson, G. B., Grant, C. S., Farley, D. R., Richards, M. L., Erickson, D. Z., Vella, A. V., Stanson, A. W., Carney, J. A., et al. (2007) · World Journal of Surgery · doi:10.1007/s00268-007-9332-8 · Cited by 120 · see citing works
Investigate electrochemical immunosensor of cortisol based on gold nanoparticles/magnetic functionalized reduced graphene oxide
Sun, B., Gou, Y., Ma, Y., Zheng, X., Bai, R., Abdelmoaty, A. A. A., & Hu, F. (2016) · Biosensors and Bioelectronics · doi:10.1016/j.bios.2016.07.047 · Cited by 117 · see citing works
Diminished urinary free cortisol excretion in patients with moderate and severe renal impairment.
Chan, K. C. A., Lit, L. C. W., Law, E. L. K., Tai, M. H. L., Yung, C. U., Chan, M. H. M., & Lam, C. W. K. (2004) · Clinical Chemistry · doi:10.1373/clinchem.2003.029934 · Cited by 99 · see citing works
Late-night salivary cortisol measurement in the diagnosis of Cushing’s syndrome
Carroll, T., Raff, H., & Findling, J. W. (2008) · Nature Clinical Practice Endocrinology & Metabolism · doi:10.1038/ncpendmet0837 · Cited by 97 · see citing works
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The diagnosis of Cushing’s syndrome
Carroll, T. B., & Findling, J. W. (2010) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-010-9143-3 · Cited by 95 · see citing works
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Screening of Cushing’s syndrome in outpatients with type 2 diabetes: results of a prospective multicentric study in Italy
Terzolo, M., Reimondo, G., Chiodini, I., Castello, R., Giordano, R., Ciccarelli, E., Limone, P., Crivellaro, C., Martinelli, I., Montini, M., et al. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2012-1323 · Cited by 89 · see citing works
Glucocorticoid response elements and 11β-hydroxysteroid dehydrogenases in the regulation of endothelial nitric oxide synthase expression
Liu, Y., Mladinov, D., Pietrusz, J. L., Usa, K., & Liang, M. (2008) · Cardiovascular Research · doi:10.1093/cvr/cvn231 · Cited by 92 · see citing works
Midnight serum cortisol as a marker of increased cardiovascular risk in patients with a clinically inapparent adrenal adenoma
Terzolo, M., Bovio, S., Pia, A., Conton, P. A., Reimondo, G., Dall’Asta, C., Bemporad, D., Angeli, A., Opocher, G., Mannelli, M., et al. (2005) · European Journal of Endocrinology · doi:10.1530/eje.1.01959 · Cited by 89 · see citing works
Surgery for Cushing’s Syndrome: An Historical Review and Recent Ten‐year Experience
Porterfield, J. R., Thompson, G. B., Young, W. F., Chow, J. T., Fryrear, R. S., II, van Heerden, J. A., Farley, D. R., Atkinson, J. L. D., Meyer, F. B., Abboud, C. F., et al. (2008) · World Journal of Surgery · doi:10.1007/s00268-007-9387-6 · Cited by 80 · see citing works
Assessment of ACTH assay variability: a multicenter study
Pecori Giraldi, F., Saccani, A., Cavagnini, F., & _, _. (2011) · European Journal of Endocrinology · doi:10.1530/eje-10-0962 · Cited by 80 · see citing works
Continuous Etomidate Infusion for the Management of Severe Cushing Syndrome: Validation of a Standard Protocol
Carroll, T. B., Peppard, W., Herrmann, D. J., Javorsky, B. R., Wang, T. S., Patel, H., Zarnecki, K., & Findling, J. W. (2018) · Journal of the Endocrine Society · doi:10.1210/js.2018-00269 · Cited by 77 · see citing works
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Circadian rhythm of salivary cortisol, plasma cortisol, and plasma ACTH in end-stage renal disease
Raff, H., & Trivedi, H. (2012) · Endocrine Connections · doi:10.1530/ec-12-0058 · Cited by 76 · see citing works
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Hyperhomocysteinemia in Patients with Cushing’s Syndrome
Terzolo, M., Allasino, B., Bosio, S., Brusa, E., Daffara, F., Ventura, M., Aroasio, E., Sacchetto, G., Reimondo, G., Angeli, A., et al. (2004) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-0079 · Cited by 75 · see citing works
Birth Weight, Family History of Diabetes, and Metabolic Syndrome in Children and Adolescents
Guerrero‐Romero, F., Aradillas-García, C., Simental‐Mendía, L. E., Monreal‐Escalante, E., Mendoza, E. D. L. C., & Rodríguez‐Morán, M. (2010) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2009.11.043 · Cited by 73 · see citing works
Cushing’s syndrome: diagnosis and surveillance using salivary cortisol
Raff, H. (2011) · Pituitary · doi:10.1007/s11102-011-0333-0 · Cited by 70 · see citing works
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Cushing’s Disease
Kaur, K., & Findling, J. W. (2008) · Humana Press eBooks · doi:10.1007/978-1-60327-103-5_3 · Cited by 71 · see citing works
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Assessment of the obese patient
Kushner, R. F., & Roth, J. L. (2003) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/s0889-8529(03)00068-9 · Cited by 66 · see citing works
Ectopic ACTH Syndrome
Isidori, A. M., Kaltsas, G., & Grossman, A. B. (2006) · KARGER eBooks · doi:10.1159/000094323 · Cited by 65 · see citing works
Insulin and Dexamethasone Dynamically Regulate Adipocyte 11β-Hydroxysteroid Dehydrogenase Type 1
Balachandran, A., Guan, H., Sellan, M. E., Uum, S. H. M. V., & Yang, K. (2008) · Endocrinology · doi:10.1210/en.2008-0088 · Cited by 57 · see citing works
On The Application of SiO2/SiC Grating on Ag for High-Performance Fiber Optic Plasmonic Sensing of Cortisol Concentration
Pandey, A. K., Sharma, A. K., & Marques, C. (2020) · Materials · doi:10.3390/ma13071623 · Cited by 56 · see citing works
Measurement of late-night salivary cortisol with an automated immunoassay system
Vogeser, M., Durner, J., Seliger, E., & Auernhammer, C. J. (2006) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm.2006.244 · Cited by 51 · see citing works
Assay-Specific Spurious ACTH Results Lead to Misdiagnosis, Unnecessary Testing, and Surgical Misadventure—A Case Series
Greene, L. W., Geer, E. B., Page‐Wilson, G., Findling, J. W., & Raff, H. (2019) · Journal of the Endocrine Society · doi:10.1210/js.2019-00027 · Cited by 49 · see citing works
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A molecularly imprinted electrochemical sensors based on bamboo-like carbon nanotubes loaded with nickel nanoclusters for highly selective detection of cortisol
Duan, D., Lu, H., Li, L., Ding, Y., & Ma, G. (2022) · Microchemical Journal · doi:10.1016/j.microc.2022.107231 · Cited by 47 · see citing works
Six controversial issues on subclinical Cushing’s syndrome
on behalf of the ABC Group, Chiodini, I., Albani, A., Ambrogio, A. G., Campo, M., Martino, M. C. D., Marcelli, G., Morelli, V., Zampetti, B., Colao, A. A. L., et al. (2016) · Endocrine · doi:10.1007/s12020-016-1017-3 · Cited by 47 · see citing works
Cushing's disease
Tritos, N. A., & Biller, B. M. K. (2014) · Handbook of clinical neurology · doi:10.1016/b978-0-444-59602-4.00015-0 · Cited by 45 · see citing works
Olfactory Neuroblastoma Causing Ectopic ACTH Syndrome
Kanno, K., Morokuma, Y., Tateno, T., Hirono, Y., Taki, K., OSAMURA, R. Y., & Hirata, Y. (2005) · Endocrine Journal · doi:10.1507/endocrj.52.675 · Cited by 41 · see citing works
Prospective Evaluation of Late-Night Salivary Cortisol and Cortisone by EIA and LC-MS/MS in Suspected Cushing Syndrome
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
“Late-night salivary cortisol (LNSC) is a reliable, simple, and cost-effective first-line test for the diagnosis of endogenous neoplastic hypercortisolism (CS) [15, 16, 34, 35, 42-52].”
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Comparison of 1 mg and 2 mg Overnight Dexamethasone Suppression Tests for the Screening of Cushing's Syndrome in Obese Patients
Şahi̇n, M., Kebapçılar, L., Taşlıpınar, A., Azal, Ö., Özgürtaş, T., Çorakçı, A., Akgül, E. Ö., Taşlıpınar, M. Y., Yazıcı, M., & Kutlu, M. (2009) · Internal Medicine · doi:10.2169/internalmedicine.48.1234 · Cited by 35 · see citing works
Cushing Syndrome
Raff, H. (2015) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2014.10.005 · Cited by 34 · see citing works
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Etomidate Use for Cushing's Syndrome Caused by an Ectopic Adrenocorticotropic Hormone–Producing Tumor
Johnson, T. N., & Canada, T. W. (2007) · Annals of Pharmacotherapy · doi:10.1345/aph.1h365 · Cited by 33 · see citing works
Salivary and serum cortisol levels during recovery from intense exercise and prolonged, moderate exercise
Powell, J. B., DiLeo, T., Roberge, R. J., Coca, A., & Kim, J.-H. (2014) · Biology of Sport · doi:10.5604/20831862.1134314 · Cited by 32 · see citing works
Ectopic Cushing' syndrome caused by a neuroendocrine carcinoma of the mesentery
Faßhauer, M., Lincke, T., Witzigmann, H., Kluge, R., Tannapfel, A., Moche, M., Buchfelder, M., Petersenn, S., Kratzsch, J., Paschke, R., et al. (2006) · BMC Cancer · doi:10.1186/1471-2407-6-108 · Cited by 32 · see citing works
Pathophysiology, Evaluation, and Medical Management of Adrenal Disorders
Kutikov, A., Crispen, P. L., & Uzzo, R. G. (2012) · Elsevier eBooks · doi:10.1016/b978-1-4160-6911-9.00057-8 · Cited by 31 · see citing works
The diagnosis and differential diagnosis of endogenous Cushing?s syndrome
Makras, P., Toloumis, G., Papadogias, D., Kaltsas, G., & Besser, M. (2006) · HORMONES · doi:10.14310/horm.2002.11189 · Cited by 31 · see citing works
Multi-matrix assay of cortisol, cortisone and corticosterone using a combined MEPS-HPLC procedure
Saracino, M. A., Iacono, C., Somaini, L., Gerra, G., Ghedini, N., & Raggi, M. A. (2013) · Journal of Pharmaceutical and Biomedical Analysis · doi:10.1016/j.jpba.2013.10.008 · Cited by 30 · see citing works
Recognition of Nonneoplastic Hypercortisolism in the Evaluation of Patients With Cushing Syndrome
Findling, J. W., & Raff, H. (2023) · Journal of the Endocrine Society · doi:10.1210/jendso/bvad087 · Cited by 30 · see citing works
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Cushing's syndrome secondary to bronchopulmonary carcinoid tumor: Report of two cases and literature review
Matos, L. L., Trufelli, D. C., das Neves-Pereira, J. C., Danel, C. J., & Riquet, M. (2006) · Lung Cancer · doi:10.1016/j.lungcan.2006.05.019 · Cited by 29 · see citing works
Diagnostic approach to Cushing disease
Gross, B. A., Mindea, S. A., Pick, A. J., Chandler, J. P., & Batjer, H. H. (2007) · Neurosurgical FOCUS · doi:10.3171/foc-07/09/e1 · Cited by 28 · see citing works
New high sensitive hydrocortisone determination by means of adsorptive stripping voltammetry on renewable mercury film silver based electrode
Smajdor, J., Piech, R., Rumin, M., & Paczosa‐Bator, B. (2015) · Electrochimica Acta · doi:10.1016/j.electacta.2015.09.057 · Cited by 27 · see citing works
MOF-Derived Ni-P Bundle-Like Nanorods as High-Performance Substrate for Design of Electrochemical Aptasensor Toward Cortisol Detection
Rahmati, Z., Roushani, M., & Hosseini, H. (2022) · IEEE Sensors Journal · doi:10.1109/jsen.2022.3229403 · Cited by 26 · see citing works
Adaptation of DELFIATM Cortisol Kit for Determination of Salivary Cortisol Concentration
Höferl, M., Krist, S., & Buchbauer, G. (2005) · Archiv der Pharmazie · doi:10.1002/ardp.200500116 · Cited by 26 · see citing works
Post-operative Day One Morning Cortisol Value as a Biomarker to Predict Long-term Remission of Cushing Disease.
Wang, 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
Management of Endocrine Emergencies in the ICU
Jacobi, J. (2019) · Journal of Pharmacy Practice · doi:10.1177/0897190019834771 · Cited by 25 · see citing works
Hair glucocorticoid levels in Parkinson's disease.
van den Heuvel, L. L., du Plessis, S., Stalder, T., Acker, D., Kirschbaum, C., Carr, J., & Seedat, S. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.104704 · Cited by 22 · see citing works
Enhanced EPR effects by tumour stromal cell mimicking nanoplatform on invasive pituitary adenoma
Ma, J., Wei, Y., Zhang, X., Lu, L., Bao, Y., Dai, L., Cao, H., Chen, H.-C., Yu, J., Yang, J., et al. (2023) · Materials Today Bio · doi:10.1016/j.mtbio.2023.100895 · Cited by 23 · see citing works
Cushing′s syndrome: Stepwise approach to diagnosis
Lila, A. R., Sarathi, V., Jagtap, V., Bandgar, T., Menon, P. S. N., & Shah, N. (2011) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/2230-8210.86974 · Cited by 23 · see citing works
A Long-Acting Neutralizing Monoclonal ACTH Antibody Blocks Corticosterone and Adrenal Gene Responses in Neonatal Rats
Gehrand, A. L., Phillips, J., Malott, K., & Raff, H. (2019) · Endocrinology · doi:10.1210/en.2019-00117 · Cited by 21 · see citing works
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Salivary cortisol is a useful tool to assess the early response to pasireotide in patients with Cushing’s disease
Trementino, L., Cardinaletti, M., Concettoni, C., Marcelli, G., Polenta, B., Spinello, M., Boscaro, M., & Arnaldi, G. (2014) · Pituitary · doi:10.1007/s11102-014-0557-x · Cited by 22 · see citing works
Subclinical Cushing Syndrome
Starker, L. F., Kunstman, J. W., & Carling, T. (2014) · Surgical Clinics of North America · doi:10.1016/j.suc.2014.02.008 · Cited by 21 · see citing works
Incidentally discovered masses in hypertensive patients
Cicala, M. V., Sartorato, P., & Mantero, F. (2006) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2006.07.009 · Cited by 21 · see citing works
Is metabolic syndrome a mild form of Cushing’s syndrome?
Krikorian, A., & Khan, M. (2010) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-010-9142-4 · Cited by 20 · see citing works
Nelson Syndrome: Update on Therapeutic Approaches
Azad, T. D., Veeravagu, A., Kumar, S., & Katznelson, L. J. (2015) · World Neurosurgery · doi:10.1016/j.wneu.2015.01.038 · Cited by 20 · see citing works
Cushing’s Syndrome due to Ectopic ACTH from Bronchial Carcinoid: A Case Report and Review
Kenchaiah, M., & Hyer, S. L. (2012) · Case Reports in Endocrinology · doi:10.1155/2012/215038 · Cited by 19 · see citing works
Surface Plasmon Resonance-Based Cortisol Sensing: A Numerical Investigation
Yang, X., Singh, H., Uniyal, A., Xu, S., Kumar, R., & Pal, A. (2025) · Plasmonics · doi:10.1007/s11468-025-02895-8 · Cited by 17 · see citing works
Factitious C ushing's syndrome masquerading as C ushing's disease
Thynne, T., White, G., & Burt, M. G. (2013) · Clinical Endocrinology · doi:10.1111/cen.12343 · Cited by 17 · see citing works
Hyperadrenocorticism of calorie restriction contributes to its anti‐inflammatory action in mice
Allen, B. D., Liao, C., Shu, J., Muglia, L. J., Majzoub, J. A., Diaz, V., & Nelson, J. F. (2019) · Aging Cell · doi:10.1111/acel.12944 · Cited by 17 · see citing works
Evaluation of endocrine tests. B: screening for hypercortisolism.
Holleman, F., Endert, E., Prummel, M. F., van Vessem-Timmermans, M., Wiersinga, W. M., & Fliers, E. (2005) · PubMed · Cited by 17 · see citing works
Neurosurgical treatment of Cushing disease
Sheth, S. A., Bourne, S. K., Tritos, N. A., & Swearingen, B. (2012) · Neurosurgery Clinics of North America · doi:10.1016/j.nec.2012.06.006 · Cited by 15 · see citing works
Physiological Basis for the Etiology, Diagnosis, and Treatment of Adrenal Disorders: Cushing's Syndrome, Adrenal Insufficiency, and Congenital Adrenal Hyperplasia
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Authors: Raff, H., & Findling, J. W.
Affiliations: Medical College of Wisconsin (US)
ORCID: Raff, Hershel
Findling, James W.
Venue: Annals of Internal Medicine
Publisher: American College of Physicians
Published: 2003-06-17
Volume: 138
Issue: 12
Pages: 980-991
ISSN: 0003-4819 (ISSN-L)
1539-3704
DOI: 10.7326/0003-4819-138-12-200306170-00010
OpenAlex: W2043931645
Cited by: 186
References: 69
Citations by year: 2026: 3 · 2025: 4 · 2024: 5 · 2023: 5 · 2022: 5 · 2021: 1 · 2020: 6 · 2019: 8 · 2018: 4 · 2017: 6 · 2016: 7 · 2015: 5 · 2014: 13 · 2013: 5 · 2012: 10
FWCI: 2.56
Type: journal article
Language: en
Open access: closed
Licence: www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations: Annals of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
Keywords: Cushing's syndrome, hypothalamic-pituitary-adrenal axis, cortisol, ACTH, 11β-hydroxysteroid dehydrogenase, metabolic syndrome, hypercortisolism, Cushing's disease, ectopic ACTH syndrome, ACTH stimulation test
MeSH terms: Cushing Syndrome, Diagnosis, Differential, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System

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A physiologic approach to diagnosis of the Cushing syndrome.

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