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. 1985 Nov 23;291(6507):1453–1457. doi: 10.1136/bmj.291.6507.1453

Five cases of cyclical Cushing's syndrome.

A B Atkinson, A L Kennedy, D J Carson, D R Hadden, J A Weaver, B Sheridan
PMCID: PMC1418075  PMID: 2998540

Abstract

Reported cases of cyclical Cushing's syndrome are rare. Of 14 successive patients with Cushing's syndrome nine collected sequential urine samples for the estimation of cortisol:creatinine ratio. Five had cyclical Cushing's syndrome while two had considerable variation in urinary cortisol excretion without a cyclical pattern being established. Two of the five patients with a cyclical syndrome had paradoxical responses to dexamethasone. In only one patient with a cyclical pattern did the cortisol:creatinine ratio fall after treatment with bromocriptine or cyproheptadine, or both. The high incidence of the cyclical form of Cushing's syndrome has important clinical implications. A high index of suspicion of the syndrome is required in patients with symptoms or signs of Cushing's syndrome but with normal cortisol values, in patients with fluctuating cortisol values, and in patients with anomalous responses to dexamethasone. Because of possible variations in steroidogenesis the results of drug studies in Cushing's syndrome must be interpreted cautiously.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aber C. P., Cheetham H. D. Cyclical Cushing's Syndrome. Br Med J. 1961 Feb 4;1(5222):336–338. doi: 10.1136/bmj.1.5222.336. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Atkinson A. B., Chestnutt A., Crothers E., Woods R., Weaver J. A., Kennedy L., Sheridan B. Cyclical Cushing's disease: two distinct rhythms in a patient with a basophil adenoma. J Clin Endocrinol Metab. 1985 Feb;60(2):328–332. doi: 10.1210/jcem-60-2-328. [DOI] [PubMed] [Google Scholar]
  3. BASSOE H. H., EMBERLAND R., STOA K. F. Fluctuating steroid excretion in Cushing's syndrome. Acta Endocrinol (Copenh) 1958 Jun;28(2):163–168. doi: 10.1530/acta.0.0280163. [DOI] [PubMed] [Google Scholar]
  4. BIRKE G., DICZFALUSY E. Fluctuation in the excretion of adrenocortical steroids in a case of Cushing's syndrome. J Clin Endocrinol Metab. 1956 Feb;16(2):286–290. doi: 10.1210/jcem-16-2-286. [DOI] [PubMed] [Google Scholar]
  5. Bailey R. E. Periodic hormonogenesis--a new phenomenon. Periodicity in function of a hormone-producing tumor in man. J Clin Endocrinol Metab. 1971 Mar;32(3):317–327. doi: 10.1210/jcem-32-3-317. [DOI] [PubMed] [Google Scholar]
  6. Blau N., Miller W. E., Miller E. R., Jr, Cervi-Skinner S. J. Spontaneous remission of Cushing's syndrome in a patient with an adrenal adenoma. J Clin Endocrinol Metab. 1975 Apr;40(4):659–663. doi: 10.1210/jcem-40-4-659. [DOI] [PubMed] [Google Scholar]
  7. Bochner F., Burke C. J., Lloyd H. M., Nurnberg B. I. Intermittent Cushing's disease. Am J Med. 1979 Sep;67(3):507–510. doi: 10.1016/0002-9343(79)90801-5. [DOI] [PubMed] [Google Scholar]
  8. Brown R. D., Van Loon G. R., Orth D. N., Liddle G. W. Cushing's disease with periodic hormonogenesis: one explanation for paradoxical response to dexamethasone. J Clin Endocrinol Metab. 1973 Mar;36(3):445–451. doi: 10.1210/jcem-36-3-445. [DOI] [PubMed] [Google Scholar]
  9. Burrow G. N., Wortzman G., Rewcastle N. B., Holgate R. C., Kovacs K. Microadenomas of the pituitary and abnormal sellar tomograms in an unselected autopsy series. N Engl J Med. 1981 Jan 15;304(3):156–158. doi: 10.1056/NEJM198101153040306. [DOI] [PubMed] [Google Scholar]
  10. Chajek T., Romanoff H. Cushing syndrome with cyclical edema and periodic secretion of corticosteroids. Arch Intern Med. 1976 Apr;136(4):441–443. [PubMed] [Google Scholar]
  11. Cook D. M., Kendall J. W., Jordan R. Cushing syndrome: current concepts of diagnosis and therapy. West J Med. 1980 Feb;132(2):111–122. [PMC free article] [PubMed] [Google Scholar]
  12. Cook J. G., Association of clinical Biochemists' Scientific and Technica Committee Factors influencing the assay of creatinine. Ann Clin Biochem. 1975 Nov;12(6):219–232. doi: 10.1177/000456327501200162. [DOI] [PubMed] [Google Scholar]
  13. Costello R. T. Subclinical Adenoma of the Pituitary Gland. Am J Pathol. 1936 Mar;12(2):205–216.1. [PMC free article] [PubMed] [Google Scholar]
  14. Crapo L. Cushing's syndrome: a review of diagnostic tests. Metabolism. 1979 Sep;28(9):955–977. doi: 10.1016/0026-0495(79)90097-0. [DOI] [PubMed] [Google Scholar]
  15. Grant D. B., Atherden S. M. Cushing's disease presenting with growth failure: clinical remission during cyproheptadine therapy. Arch Dis Child. 1979 Jun;54(6):466–468. doi: 10.1136/adc.54.6.466. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Green J. R., van't Hoff W. Cushing's syndrome with fluctuation due to adrenal adenoma. J Clin Endocrinol Metab. 1975 Aug;41(2):235–240. doi: 10.1210/jcem-41-2-235. [DOI] [PubMed] [Google Scholar]
  17. Halberg F., Engeli M., Hamburger C. The 17-ketosteroid excretion of a healthy man on weekdays and weekends. Exp Med Surg. 1965;23(1):61–69. [PubMed] [Google Scholar]
  18. Hsu T. H., Gann D. S., Tsan K. W., Russell R. P. Cyproheptadine in the control of Cushing's disease. Johns Hopkins Med J. 1981 Aug;149(2):77–83. [PubMed] [Google Scholar]
  19. Jordan R. M., Ramos-Gabatin A., Kendall J. W., Gaudette D., Walls R. C. Dynamics of adrenocorticotropin (ACTH) secretion in cyclic Cushing's syndrome: evidence for more than one abnormal ACTH biorhythm. J Clin Endocrinol Metab. 1982 Sep;55(3):531–537. doi: 10.1210/jcem-55-3-531. [DOI] [PubMed] [Google Scholar]
  20. Kennedy A. L., Sheridan B., Montgomery D. A. ACTH and cortisol response to bromocriptine, and results of long-term therapy, in Cushing's disease. Acta Endocrinol (Copenh) 1978 Nov;89(3):461–468. doi: 10.1530/acta.0.0890461. [DOI] [PubMed] [Google Scholar]
  21. Krieger D. T., Amorosa L., Linick F. Cyproheptadine-induced remission of Cushing's disease. N Engl J Med. 1975 Oct 30;293(18):893–896. doi: 10.1056/NEJM197510302931802. [DOI] [PubMed] [Google Scholar]
  22. Lamberts S. W., Klijn J. G., de Quijada M., Timmermans H. A., Uitterlinden P., de Jong F. H., Birkenhäger J. C. The mechanism of the suppressive action of bromocriptine on adrenocorticotropin secretion in patients with Cushing's disease and Nelson's syndrome. J Clin Endocrinol Metab. 1980 Aug;51(2):307–311. doi: 10.1210/jcem-51-2-307. [DOI] [PubMed] [Google Scholar]
  23. Liberman B., Wajchenberg B. L., Tambascia M. A., Mesquita C. H. Periodic remission in Cushing's disease with paradoxical dexamethasone response: an expression of periodic hormonogenesis. J Clin Endocrinol Metab. 1976 Oct;43(4):913–918. doi: 10.1210/jcem-43-4-913. [DOI] [PubMed] [Google Scholar]
  24. Oates T. W., McCourt J. P., Friedman W. A., Agee O. F., Rhoton A. L., Thomas W. C., Jr Cushing's disease with cyclic hormonogenesis and diabetes insipidus. Neurosurgery. 1979 Nov;5(5):598–603. doi: 10.1227/00006123-197911000-00010. [DOI] [PubMed] [Google Scholar]
  25. PASQUALINI R. Q., GUREVICH N. Spontaneous remission in a case of Cushing's syndrome. J Clin Endocrinol Metab. 1956 Mar;16(3):406–411. doi: 10.1210/jcem-16-3-406. [DOI] [PubMed] [Google Scholar]
  26. Riad-Fahmy D., Read G. F., Gaskell S. J., Dyas J., Hindawi R. A simple, direct radioimmunoassay for plasma cortisol, featuring a 125I radioligand and a solid-phase separation technique. Clin Chem. 1979 May;25(5):665–668. [PubMed] [Google Scholar]
  27. Schteingart D. E., McKenzie A. K. Twelve-hour cycles of adrenocorticotropin and cortisol secretion in Cushing's disease. J Clin Endocrinol Metab. 1980 Nov;51(5):1195–1198. doi: 10.1210/jcem-51-5-1195. [DOI] [PubMed] [Google Scholar]
  28. Scott R. S., Espiner E. A., Donald R. A. Intermittent Cushing's disease with spontaneous remission. Clin Endocrinol (Oxf) 1979 Nov;11(5):561–566. doi: 10.1111/j.1365-2265.1979.tb03109.x. [DOI] [PubMed] [Google Scholar]
  29. Spark R. F., Dickstein G. Bromocriptine and endocrine disorders. Ann Intern Med. 1979 Jun;90(6):949–956. doi: 10.7326/0003-4819-90-6-949. [DOI] [PubMed] [Google Scholar]

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