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Cushing's Syndrome. Great Neck, NY: National Adrenal Diseases Foundation. 2006. 8 p.

Cushing’s syndrome is a disease caused by an excess of cortisol production or by excessive use of cortisol or other similar steroid hormones. The normal function of cortisol is to mobilize nutrients, modify the body’s response to inflammation, stimulate the liver to raise the blood sugar, and help to control the amount of water in the body. This brochure reviews the basic facts about Cushing’s syndrome. Topics include the normal physiology of the adrenal glands, the pathology of the disease, the causes of Cushing’s syndrome, the incidence of Cushing’s syndrome, the symptoms and signs of the disorder, diagnostic tests used to confirm the presence of Cushing’s syndrome, treatment options, the role of the endocrinologist in the care of patients with Cushing’s disease, and quality of life issues. The brochure concludes with a brief description of the National Adrenal Diseases Foundation (NADF), a non-profit organization providing information, education and support to all persons affected by adrenal disease. Readers are referred to three different web sites for additional information. 2 figures.

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Cushing’s Syndrome. Bethesda, MD: National Endocrine and Metabolic Diseases Information Service. 2008. 11 p.

This fact sheet provides information about Cushing’s syndrome, a hormonal disorder caused by prolonged exposure of the body’s tissues to high levels of the hormone cortisol. Written in a question-and-answer format, the fact sheet outlines the signs and symptoms of Cushing’s syndrome, causes, diagnostic tests that may be used to confirm the presence of Cushing’s syndrome, treatment options, and current research efforts in this area. Specific topics include the role of cortisol in the body, pituitary adenomas, ectopic adrenocorticotropin hormone (ACTH) syndrome, adrenal tumors, familial Cushing’s syndrome, surgical treatments, radiation, chemotherapy, and the use of cortisol-inhibiting drugs. Typical signs and symptoms of Cushing’s disease include upper body obesity, a rounded face, skin that bruises easily and heals poorly, weakened bones, excess body hair growth, menstrual irregularities in women, and decreased fertility in men. Cushing’s syndrome is caused by exposure to glucocorticoids, which are used to treat inflammatory diseases, or by the body’s overproduction of cortisol, most often due to tumors of the pituitary gland or lung. Treatment is determined by the specific reason for excess cortisol. The fact sheet concludes with a list of resource organizations where readers can get more information and a brief description of the activities of the National Endocrine and Metabolic Diseases Information Service. 1 figure.

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Patient Guide to the Diagnosis of Cushing‘s Syndrome. Chevy Chase, MD: Hormone Foundation. 2008. 2 p.

This fact sheet describes Cushing’s syndrome (CS), a condition that results from having too much of the hormone cortisol in the bloodstream for a prolonged period of time. The fact sheet focuses on the diagnosis of CS, which can be difficult because many of the symptoms are not unique to this condition. There are two types of CS: external, which is more common, caused by taking medications containing glucocorticoids; and internal CS, caused by the body’s overproduction of the hormone. Diagnosis is characterized first by a detailed patient history, designed to elicit details about glucocorticoid use in any form. The author cautions that some skin creams, herbal medications, tonics, and joint or nerve injections may include glucocorticoids. Other diagnostic approaches include identifying patients with unusual signs and symptoms for their age, with several and worsening symptoms of CS, and patients with a mass on the adrenal gland, which is the gland that produces cortisol. The fact sheet describes four recommended diagnostic tests that may be used: urine free cortisol (UFC), late-night salivary cortisol, 1-milligram overnight dexamethasone suppression test (DST), and longer DST—2 milligrams per day for 48 hours. Two final sections report on which tests are recommended for which patients and what patients can do to take an active role in the diagnostic process. Readers are referred to the Hormone Foundation’s website at www.hormone.org for more information. 2 figures.

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Adrenal Disorders. IN: Camacho, P.M.; Gharib, H.; Sizemore, G.W., eds. Evidence-Based Endocrinology. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins. 2007. pp 57-84.

This chapter on adrenal disorders is from a concise, reference-based handbook that is intended to help busy clinicians with endocrine-related diagnostic and therapeutic decisions required in their practices. Using a modification of the McMaster criteria, the contributors to the text have critically assessed and graded studies, assisting readers in quickly evaluating the articles that have led to practice recommendations. Topics covered in this chapter include evaluation of adrenal function, adrenal imaging, primary hyperaldosteronism, Cushing syndrome, adrenal incidentaloma, adrenal insufficiency, and pheochromocytoma. For each disease state included, the authors discuss etiology, epidemiology, pathophysiology, diagnosis, and treatment considerations. The chapter includes an outline and an extensive, annotated list of references. 4 tables. 95 references.

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Endocrine Hypertension. IN: Gardner, D.; Shoback, D., eds. Greenspan’s Basic and Clinical Endocrinology. 8th ed. Columbus, OH: McGraw Hill. 2007. pp 396-420.

This chapter about endocrine hypertension is from a textbook about endocrinology that describes the scientific principles and clinical management of patients with endocrine-related diseases and disorders. The authors note that although the kidney is not an endocrine organ per se, its role as both the origin of and target tissue for the hormones that comprise the renin-angiotensin-aldosterone system make hypertensive disorders of kidney origin an appropriate subject for a chapter on endocrine hypertension. Hypertension can be a prominent feature of other endocrine disorders, including acromegaly, thyrotoxicosis, hypothyroidism, and hyperparathyroidism, but these are discussed elsewhere in the text. In this chapter, the authors discuss the synthesis, metabolism, and action of mineralocorticoid hormones; the pathogenesis of mineralocorticoid hypertension; aldosterone and the heart; primary aldosteronism; syndromes due to excess deoxycorticosterone production; Cushing’s syndrome; pseudohyperaldosteronism; hypertension of renal origin; the renin-angiotensin system and hypertension; and other hormone systems and hypertension, including insulin, the natriuretic peptides, nitric oxide, endothelin, the kallikrein-kinin system, and the sympathetic nervous system. The chapter includes numerous black-and-white photographs and illustrations; a list of abbreviations is provided. 11 figures. 1 table. 15 references.

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Glucocorticoids and Adrenal Androgens. IN: Gardner, D.; Shoback, D., eds. Greenspan’s Basic and Clinical Endocrinology. 8th ed. Columbus, OH: McGraw Hill. 2007. pp 346-395.

This chapter about glucocorticoids and adrenal androgens is from a textbook about endocrinology that describes the scientific principles and clinical management of patients with endocrine-related diseases and disorders. The authors discuss the biologic effects of adrenal steroids, disorders of adrenocortical insufficiency, Cushing’s syndrome, hirsutism and virilism, and incidental adrenal mass. They note that advances in diagnostic procedures have simplified the evaluation of adrenocortical disorders; notably, the assay of plasma glucocorticoids, androgens, and adrenocorticotropin (ACTH) has allowed more rapid and precise diagnosis. In addition, advances in surgical and medical treatment have improved the outlook for patients with these disorders. The chapter includes numerous black-and-white photographs and illustrations; a list of abbreviations is provided. 15 figures. 14 tables. 108 references.

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Humoral Manifestations of Malignancy. IN: Gardner, D.; Shoback, D., eds. Greenspan’s Basic and Clinical Endocrinology. 8th ed. Columbus, OH: McGraw Hill. 2007. pp 817-830.

This chapter about the humoral manifestations of malignancy is from a textbook about endocrinology that describes the scientific principles and clinical management of patients with endocrine-related diseases and disorders. The authors note that both endocrine and nonendocrine tumors secrete polypeptide hormones. Topics discussed include ectopic hormone and receptor syndromes, hypercalcemia of malignancy, ectopic Cushing’s syndrome, syndrome of inappropriate antidiuretic hormone secretion, non-islet cell tumors and hypoglycemia, other hormones secreted by tumors, oncogenic osteomalacia, and gut hormones. A list of abbreviations is provided. 4 tables. 38 references.

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Natural History of Obesity: Differential Diagnosis, Clinical Types, and Age-Related Changes. IN: Bray, G.A. Metabolic Syndrome and Obesity. Totowa, NJ: Humana Press. 2007. pp 93-122.

This chapter about the natural history of obesity is from a book that presents an up-to-date survey of the current scientific understanding of obesity and the metabolic syndrome, as well as an overview of the most significant changes in the field in the past 30 years. This chapter is a transition from the basic concepts already discussed to a consideration of the types of clinical settings that are associated with increasing body fat. The author begins with the importance of including genetic factors as part of the discussion of the differential diagnosis of obesity. Polygenic causes of excess body fat include congenital disorder or genetic syndromes causing excess fat; and neuroendocrine causes of overweight can include hypothalamic causes of overweight, Cushing's syndrome, polycystic ovary syndrome (POS), growth hormone deficiency, hypothyroidism, and hyperparathyroidism. The chapter looks at age-related events that can precipitate increasing rates of fat deposition. The author stresses that weight gain in different times of life often has different causes. One section considers behavioral, psychological, and social factors, including restrained eating, binge-eating disorder, night-eating syndrome, socioeconomic factors, and ethnic factors. The chapter includes an outline, figures and tables; it concludes with an extensive list of references. 8 figures. 7 tables. 100 references.

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American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Hypertension. Endocrine Practice. 12(2): 193-222. March-April 2006.

This article presents the American Association of Clinical Endocrinologists (AACE) medical guidelines for clinical practice for the diagnosis and treatment of hypertension. The guidelines focus on identifying and managing hypertension secondary to or coincident with endocrinopathies, such as diabetes mellitus. The AACE contends that understanding the associated pathophysiologic features of hypertension will guide appropriate treatment and thus help physicians anticipate the usefulness of evolving therapies, such as blockade of the renin-angiotensin systems for retarding the progression of retinopathy and nephropathy in patients with diabetes. The objectives of the guidelines are to indicate when to suspect the presence of and pursue further testing for secondary hypertension; provide appropriate examples of the most common causes of endocrine-associated hypertension that physicians my encounter; elucidate the cause of each endocrine disorder underlying hypertension; describe the tests used to confirm each diagnosis; identify the appropriate management options for each condition based on the available evidence and known pathophysiologic changes; and discuss outcomes and potential side effects associated with each management option. In addition to diabetes, the guidelines cover coronary or peripheral vascular disease; glucocorticoid excess (Cushing’s syndrome); genetic diseases; disorders of the adrenal, thyroid, parathyroid, and pituitary glands; abnormal renal tubular sodium handling; and renin-secreting tumors. 3 figures. 7 tables. 187 references.

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Disorders of the Adrenal Cortex. IN: Jameson, J.L., ed. Harrison's Endocrinology. Columbus, OH: McGraw Hill. 2006. pp 113-150.

This chapter on disorders of the adrenal cortex is from a textbook that offers a comprehensive, practical look at the field of endocrinology. The adrenal cortex produces three major classes of steroids: glucocorticoids, mineralocorticoids, and adrenal androgens. Thus, normal adrenal function is involved in modulating intermediary metabolism and immune responses; blood pressure, vascular volume, and electrolytes; and secondary sexual characteristics in females. The authors discuss biochemistry and physiology, the laboratory evaluation of adrenocortical function, hyperfunction of the adrenal cortex including Cushing's syndrome and aldosteronism, hypofunction of the adrenal cortex, hypoaldosteronism, and the pharmacologic clinical uses of adrenal steroids. Specific topics covered include steroid nomenclature, the biosynthesis of adrenal steroids, steroid transport, steroid metabolism and excretion, adrenocorticotropic hormone (ACTH) physiology, renin-angiotensin physiology, glucocorticoid physiology, mineralocorticoid physiology, and androgen physiology. The chapter includes full-color illustrations and black-and-white photographs. 11 figures. 11 tables. 16 references.

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