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A physiologic approach to diagnosis of the Cushing syndrome.
Abstract
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 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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Metadata
- Authors
- Raff, H., & Findling, J. W.
- Affiliations
- Medical College of Wisconsin (US)
- 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
- 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
- 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 › Nephrology › 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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