Navegando por Palavras-chave "Hipercortisolismo"
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- ItemAcesso aberto (Open Access)Aumento da probabilidade diagnóstica de Síndrome de Cushing subclínica em amostra de população de pacientes obesos com diabetes mellitus do tipo 2(Universidade Federal de São Paulo (UNIFESP), 2008-06-27) Caetano, Maria Silvia Santarem [UNIFESP]; Kater, Claudio Elias [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Endogenous Cushing’s syndrome (CS) is unusual. Patients with subclinical CS (SCS) present altered cortisol dynamics without obvious manifestations. CS occurs in 2-3% of obese poorly controlled diabetics. We studied 103 overweight adult outpatients with type 2 diabetes to examine for cortisol abnormalities and SCS. All collected salivary cortisol at 23:00h and salivary and serum cortisol after a 1mg dexamethasone suppression test (DST). Patients whose results were in the upper quintile for each test (253ng/dL, 47ng/dL and 1.8ìg/dL, respectively for the 23:00h and post-DST saliva and serum cortisol) were re-investigated. Average values from the upper quintile group were 2.5- fold higher than in the remaining patients. After a confirmatory 2mgx2day DST the investigation for CS was ended for 61 patients with all normal tests and 33 with only one (false) positive test. All 8 patients who had two abnormal tests had subsequent normal 24h-urinary cortisol, and 3 of them were likely to have SCS (abnormal cortisol tests and positive imaging). However, a final diagnosis could not to be confirmed by surgery or pathology. Although not confirmatory, the results of this study suggest that the prevalence of SCS is considerably higher in populations at risk than in the general population.
- ItemAcesso aberto (Open Access)Hipercortisolismo subclínico cíclico : uma forma de hipersecreção previamente não identificada dos Incidentalomas de Adrenal(Universidade Federal de São Paulo (UNIFESP), 2019-08-29) Giorgi, Rafael Buck [UNIFESP]; Kater, Claudio Elias [UNIFESP]; Barbosa, Flávia A. Costa [UNIFESP]; http://lattes.cnpq.br/2782023766642704; http://lattes.cnpq.br/1250728429385385; http://lattes.cnpq.br/1634373557574323; Universidade Federal de São Paulo (UNIFESP)Purpose: Most adrenal incidentalomas (AI) are non-functioning adenomas (NFA), but up to 30% may secrete cortisol autonomously without clinical evidence of Cushing’s syndrome (CS) that nevertheless may increase cardiovascular mortality. This subclinical hypercortisolism (SCH) is confirmed by cortisol resistance to a dexamethasone suppression test (DST). Cyclic cortisol secretion occurs in classic CS but was not reported in SCH. Objective: Investigate cyclic cortisol production/autonomy in AI using sequential DST. Methods: 251 AI patients underwent 487 DST along 12 years; patients with at least 3 (3+) DST were selected. DSTs were validated by measuring serum dexamethasone. Cyclic SCH was defined when at least 2 abnormal and 2 normal DST were documented. Results: 44 patients had 3+ DST during follow-up: 9/44 patients (20.4%) had all tests negative (post-DST cortisol ≤1.8g/dL) being classified as NFA; another 9 had all tests positive (cortisol >1.8g/dL) and were grouped as sustained SCH. The remaining 26 (59.2%) had discordant responses: 8/44 (18.3%) had at least 2 positive and 2 negative tests, matching the criterion for cyclic SCH, whereas 18/44 (40.9%) had only one discordant test, being considered possibly cyclic SCH. Eleven of 20 (55%) patients initially diagnosed as NFA did not maintain their cortisol pattern subsequently. Conclusions: Extended follow-up with repeated DST uncovered an unusual subset of AI with cyclic SCH. Recurring production of cortisol may puzzle investigation of AI subtypes if based on just one DST. Lack of recognition of this phenomenon makes followup of AI patients misleading, since even cyclic SCH may result in potential CV risk.
- ItemAcesso aberto (Open Access)Increased diagnostic probability of subclinical cushing s syndrome in a population sample of overweight adult patients with type 2 diabetes mellitus(Sociedade Brasileira de Endocrinologia e Metabologia, 2007-10-01) Caetano, Maria Silvia S. [UNIFESP]; Silva, Regina do Carmo [UNIFESP]; Kater, Claudio Elias [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Endogenous Cushing s Syndrome (CS) is unusual. Patients with subclinical CS (SCS) present altered cortisol dynamics without obvious manifestations. CS occurs in 2-3% of obese poorly controlled diabetics. We studied 103 overweight adult outpatients with type 2 diabetes to examine for cortisol abnormalities and SCS. All collected salivary cortisol at 23:00 h and salivary and serum cortisol after a 1 mg dexamethasone suppression test (DST). Patients whose results were in the upper quintile for each test (253 ng/dL, 47 ng/dL, and 1.8 mg/dL, respectively for the 23:00 h and post-DST saliva and serum cortisol) were re-investigated. Average values from the upper quintile group were 2.5-fold higher than in the remaining patients. After a confirmatory 2 mg x 2 day DST the investigation for CS was ended for 61 patients with all normal tests and 33 with only one (false) positive test. All 8 patients who had two abnormal tests had subsequent normal 24h-urinary cortisol, and 3 of them were likely to have SCS (abnormal cortisol tests and positive imaging). However, a final diagnosis could not to be confirmed by surgery or pathology. Although not confirmatory, the results of this study suggest that the prevalence of SCS is considerably higher in populations at risk than in the general population.
- ItemAcesso aberto (Open Access)Síndrome de Cushing subclínica em populações de risco(Sociedade Brasileira de Endocrinologia e Metabologia, 2007-11-01) Caetano, Maria Silvia S. [UNIFESP]; Vilar, Lucio; Kater, Claudio Elias [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Pernambuco Hospital das Clínicas Divisão de EndocrinologiaBased on autopsy studies, adrenal masses are among the most common tumors in humans. Endogenous Cushing's syndrome (CS) is unusual and adrenal adenomas account for 10% of all cases of CS. Patients with subclinical CS (SCS) present abnormal cortisol dynamics without obvious manifestations. The prevalence of hypercortisolism in clinically inapparent adrenal masses has been reported as 9%. Data from several small series of patients indicate that fewer than 20% develop hormone overproduction when followed for up to 10 years. Follow-up of patients with subclinical CS suggests that rarely masses increase in size or progress to overt CS. Adrenal incidentalomas and subclinical CS are related to metabolic disorders, in special to type-2 diabetes. The scarce available data suggest that treatment of hypercortisolism correct the metabolic abnormalities and blood pressure. Some studies evaluating the prevalence of subclinical CS in overweight type-2 diabetes patients suggest that it is considerably higher in populations at risk than in the general population.