Current perspectives on Cushing's syndrome: diagnostic and therapeutic bases

Authors

  • Paulo Vytor Cardoso Nobre universidade Federal de Alagoas
  • Alice Wanderley Rosa Acadêmico de Medicina pelo Centro Universitário de Maceió
  • Marcos Fernando de Brito Malta Acadêmico de Medicina pelo Centro de Estudos Superiores de Maceió
  • Hérica Silva Florentino Acadêmico de Medicina pelo Centro Universitário de Maceió
  • Marcos Antônio Gomes de Oliveira Acadêmico de Medicina pelo Centro Universitário de Maceió
  • Maria Renata Gerbase Vidal Acadêmico de Medicina pelo Centro Universitário de Maceió
  • Karine Inês Costa Cordeiro Acadêmico de Medicina pelo Centro Universitário de Maceió
  • Caroline Lavinas Lúcio da Silva Acadêmico de Medicina pelo Centro Universitário de Maceió
  • Thierry de Lima Almeida Reis Acadêmico de Medicina pela Universidade Federal de Alagoas
  • Nayara Fernanda Amorim Madeiros Ribeiro Acadêmico de Medicina pelo Centro de Estudos Superiores de Maceió
  • Juliana Silva Ribeiro Médica pela Universidad de Buenos Aires
  • Everton Filipe Vieira Rodrigues Acadêmico de Medicina pela Universidade Federal de Alagoas

DOI:

https://doi.org/10.36557/2674-8169.2024v6n4p614-624

Keywords:

cushing's syndrome, cushing's disease, diagnosis, treatment

Abstract

Introduction: Cushing's syndrome (CS) is a medical condition resulting from chronic and excessive exposure to high levels of cortisol, whether of endogenous or exogenous origin. Common symptoms include central obesity, redistribution of body fat, muscle weakness, high blood pressure, increased blood glucose, skin fragility and susceptibility to infections. Objective: To evaluate the diagnostic and therapeutic aspects of Cushing's syndrome. Methodology: This is a bibliographic review that included original articles and systematic reviews in English and Portuguese, which addressed the diagnosis and treatment of CS, published between 2012 and 2024, selected from the PubMed, Scopus and SciELO databases. After careful selection, 21 articles were chosen to compose this bibliographic review. Results: CS is a complete condition and can use several diagnostic methods to discover the condition and etiology, such as measuring nocturnal salivary cortisol, urinary free cortisol, low-dose dexamethasone suppression test and imaging tests. Treatment varies depending on the etiology and includes transsphenoidal surgery, surgical excision of the extrapituitary tumor, or adrenalectomy. Pharmacological measures can be applied, such as inhibitors of cortisol synthesis and ACTH secretion. Considerations: CS presents a wide range of clinical symptoms, and biochemical confirmation of hypercortisolism and measurement of ACTH is crucial, in addition to the use of imaging tests. Management aims to resolve the underlying cause, using surgical and pharmacological interventions, with the aim of promoting a better quality of life for patients.

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References

Bozkurt, M. F., Virgolini, I., Balogova, S., Beheshti, M., Rubello, D., Decristoforo, C., ... & Giammarile, F. (2017). Guidelines for PET/CT imaging of neuroendocrine neoplasms with peptide receptor radiopharmaceuticals 68Ga-DOTA-conjugated somatostatin receptor targeting peptides and 18F-DOPA. European Journal of Nuclear Medicine and Molecular Imaging, 44(9), 1588–1601.

Castinetti, F., Guignat, L., Giraud, P., Muller, M., Kamenicky, P., Drui, D., ... & Brue, T. (2014). Ketoconazole in Cushing's disease: is it worth a try? The Journal of Clinical Endocrinology & Metabolism, 99(5), 1623–1630.

Chatain, G. P., Patronas, N., Smirniotopoulos, J. G., Piazza, M., Benzo, S., Ray-Chaudhury, A., ... & Caturegli, P. (2018). Potential utility of FLAIR in Cushing disease with negative magnetic resonance imaging. Journal of Neurosurgery, 129(3), 620–628.

Colao, A., Petersenn, S., Newell-Price, J., Findling, J. W., Gu, F., Maldonado, M., ... & Pasireotide B2305 Study Group. (2012). A 12-month phase 3 study of pasireotide in Cushing's disease. New England Journal of Medicine, 366(10), 914–924.

Daniel, E., Aylwin, S., Mustafa, O., Ball, S., Munir, A., Boelaert, K., ... & Newell-Price, J. (2015). Effectiveness of metyrapone in treating Cushing's syndrome: a retrospective multicenter study in 195 patients. The Journal of Clinical Endocrinology & Metabolism, 100(11), 4146–4154.

Fassnacht, M., Dekkers, O. M., Else, T., Baudin, E., Berruti, A., de Krijger, R., ... & Terzolo, M. (2018). European Society of Endocrinology clinical practice guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors. European Journal of Endocrinology, 179(4), G1–G46.

Ferriere, A., Cortet, C., Chanson, P., Delemer, B., Caron, P., Chabre, O., ... & Tabarin, A. (2017). Cabergoline for Cushing's disease: a large, retrospective multicenter study. European Journal of Endocrinology, 176(3), 305–314.

Fleseriu, M., Pivonello, R., Young, J., Hamrahian, A. H., Molitch, M. E., Shimizu, C., ... & Bertagna, X. (2016). Osilodrostat, a potent oral 11β-hydroxylase inhibitor: a multicenter, prospective phase II study in Cushing's disease. Pituitary, 19(2), 138–148.

Galm, B. P., Qiao, N., Klibanski, A., Biller, B. M. K., & Tritos, N. A. (2020). Accuracy of laboratory tests for Cushing’s syndrome diagnosis. The Journal of Clinical Endocrinology & Metabolism, 105(6).

Greene, L. W., Geer, E. B., Page-Wilson, G., Findling, J. W., & Raff, H. (2019). Spurious ACTH assay results lead to incorrect diagnoses, unnecessary testing, and a series of surgical misadventures. Journal of the Endocrine Society, 3(4), 763–772.

Hamblin, R., Coulden, A., Fountas, A., & Karavitaki, N. (2022). Diagnosis and management of Cushing's syndrome in pregnancy. Journal of Neuroendocrinology, 34(8), e13118.

Issa, B. G., Hanna, F. W. F., Fryer, A. A., Ensah, G., Ebere, I., Marshall, D., ... & Metherell, L. A. (2023). The utility of salivary cortisol in overnight dexamethasone suppression test in adrenal incidentalomas. The Journal of Clinical Endocrinology & Metabolism, 25(5), 698–700.

Lacroix, A., Feelders, R. A., Stratakis, C. A., & Nieman, L. K. (2015). Cushing's syndrome. The Lancet, 386(9996), 913–927.

Pivonello, R., De Leo, M., Cozzolino, A., & Colao, A. (2015). The treatment of Cushing's disease. Endocrine Reviews, 36(4), 385–486.

Pivonello, R., Isidori, A. M., De Martino, M. C., Newell-Price, J., Biller, B. M., & Colao, A. (2016). Complications of Cushing's syndrome: state of the art. The Lancet Diabetes & Endocrinology, 4(7), 611–629.

Raff, H., & Carroll, T. (2015). Cushing's syndrome: from physiological principles to diagnosis and clinical care. The Journal of Physiology, 593(3), 493–506.

Sharma, S. T., Nieman, L. K., & Feelders, R. A. (2015). Cushing's syndrome: epidemiology and developments in disease management. Clinical Epidemiology, 7, 281–293.

Valassi, E., Franz, H., Brue, T., Feelders, R. A., Netea-Maier, R., Tsagarakis, S., ... & Arlt, W. (2017). Diagnostic tests for Cushing's syndrome differ from published guidelines: data from ERCUSYN. European Journal of Endocrinology, 176(5), 613–624.

Wagner-Bartak, N. A., Baiomy, A., Habra, M. A., Mukhi, S. V., Morani, A. C., Korivi, B. R., ... & Lano, E. (2017). Cushing syndrome: diagnostic workup and imaging features, with clinical and pathologic correlation. American Journal of Roentgenology, 209(1), 19–32.

Wang, H., Ba, Y., Xing, Q., & Cai, R. C. (2020). Differential diagnostic value of bilateral inferior petrosal sinus sampling (BIPSS) in ACTH-dependent Cushing’s

Wei, J., Li, S., Liu, Q., Zhu, Y., Wu, N., Tang, Y., ... & Li, Z. (2018). ACTH-independent Cushing’s syndrome with bilateral cortisol-secreting adrenal adenomas: a case report and literature review. BMC Endocrine Disorders, 18(1), 22.

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Published

2024-04-06

How to Cite

Vytor Cardoso Nobre, P., Wanderley Rosa, A., Fernando de Brito Malta, M., Silva Florentino , H., Antônio Gomes de Oliveira , M., Renata Gerbase Vidal , M., Inês Costa Cordeiro , K., Lavinas Lúcio da Silva, C., de Lima Almeida Reis, T., Fernanda Amorim Madeiros Ribeiro, N., Silva Ribeiro, J., & Filipe Vieira Rodrigues , E. (2024). Current perspectives on Cushing’s syndrome: diagnostic and therapeutic bases. Brazilian Journal of Implantology and Health Sciences, 6(4), 614–624. https://doi.org/10.36557/2674-8169.2024v6n4p614-624

Issue

Vol. 6 No. 4 (2024): BJIHS QUALIS B3 - IMPACT FACTOR SJIF 5.807

Section

Original article

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Copyright (c) 2024 Paulo Vytor Cardoso Nobre, Alice Wanderley Rosa, Marcos Fernando de Brito Malta, Hérica Silva Florentino , Marcos Antônio Gomes de Oliveira , Maria Renata Gerbase Vidal , Karine Inês Costa Cordeiro , Caroline Lavinas Lúcio da Silva, Thierry de Lima Almeida Reis, Nayara Fernanda Amorim Madeiros Ribeiro, Juliana Silva Ribeiro, Everton Filipe Vieira Rodrigues

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