obsolete Cushing's syndrome

Obsolete Cushing's Syndrome

Cushing's syndrome, as described in the past (resulting from outdated information), refers to a group of diseases characterized by excessive cortisol production. This condition was previously known as Cushing Syndrome/ultrasonography, Cushing Syndrome/diagnosis, and other obsolete terms.

Causes and Symptoms

The adrenal gland's overproduction of cortisol leads to this syndrome, causing symptoms such as:

• A round face ("moon" face)
• Thin arms and legs
• Severe fatigue and muscle weakness
• High blood pressure
• Striae (stretch marks)

These symptoms can vary in severity and are often nonspecific, making diagnosis challenging.

Diagnosis and Treatment

The recommended screening tests for Cushing's syndrome include the 1mg overnight dexamethasone suppression test, late-night salivary cortisol, and 24-hour urinary free cortisol. However, without treatment, this condition can lead to complications such as:

• Complications from untreated Cushing syndrome

Prevalence and Age Range

Cushing syndrome is believed to be underdiagnosed, with the most common age at diagnosis ranging from 30 through 49 years. However, it can be diagnosed in people as young as 5 or as old as 75.

References:

• [1] - Obsolete term for Cushing Syndrome/ultrasonography
• [4] - Description of obsolete Cushing's syndrome
• [13] - Complications from untreated Cushing syndrome
• [14] - Underdiagnosis and age range of diagnosis

Obsolete Signs and Symptoms of Cushing's Syndrome

While Cushing's syndrome is no longer considered a distinct entity, its symptoms can still be relevant in understanding the condition. According to various medical sources [1][2][3], some common signs and symptoms of what was previously known as Cushing's syndrome include:

• Weight gain: Obesity and weight gain are among the most common signs in Cushing's syndrome [4].
• Fatty tissue deposits: Fatty tissue deposits, particularly around the midsection and upper back, in the face (moon face), and at the base of the neck can be indicative of this condition [5][6].
• Thin skin: Thin skin, easy bruising, and muscle weakness are key indicators of Cushing's syndrome [7].
• Central adiposity: Central fat distribution, also known as central adiposity, is a common feature of Cushing's syndrome [8].
• Moon facies: A round face or facial plethora can be a sign of this condition [9][10].

It's essential to note that these symptoms may resemble other conditions or medical problems. Always consult a doctor for an accurate diagnosis.

References:

[1] Juszczak, A. (2021). Cushing's syndrome: A review of the literature. [Context result 1]

[2] Fujii, Y. (2018). Cushing's syndrome: A clinical and pathological study. [Context result 8]

[3] Orphanet. (Obsoleted) Cushing's syndrome. [Context result 6]

[4] Sep 5, 2024 - Symptoms of Cushing Syndrome. [Context result 9]

[5] Aug 16, 2017 - Common signs and symptoms include central adiposity, roundness of the face or extra fat around the neck, thin skin, impaired short-term memory, etc. [Context result 4]

[6] Oct 9, 2020 - The signs and symptoms most suggestive of underlying hypercortisolism include facial plethora, moon facies, proximal muscle weakness, central adiposity, etc. [Context result 5]

[7] While thin skin, easy bruising, and muscle weakness are key indicators, not all patients exhibit these features. Confirming Cushing's disease (CD) requires further diagnostic procedures. [Context result 7]

[8] by Y Fujii · 2018 · Cited by 16 — Common features of Cushing's syndrome include centripetal fat deposition, abdominal striae, facial plethora, muscle atrophy, bone density loss, etc. [Context result 8]

[9] Sep 5, 2024 - Obesity and weight gain are among the most common signs in Cushing's syndrome. The distribution of fat can be useful, as typically in Cushing's... [Context result 9]

[10] Jul 19, 2024 - Symptoms of Cushing Syndrome · Weight gain · Fatty tissue deposits, particularly around the midsection and upper back, in the face (moon face), etc. [Context result 3]

Based on the provided context, it appears that there are several diagnostic tests for Cushing's syndrome (CS) that have been deemed obsolete or less accurate compared to others.

Obsolete Diagnostic Tests

• Urinary 17-ketosteroids: This test has a low diagnostic accuracy and is no longer recommended for diagnosing CS [11].
• Random cortisol levels: Measuring random cortisol levels, such as at 1600 h, also has a low diagnostic accuracy and is not recommended for testing [11].
• Insulin tolerance test: This test was previously advocated for the diagnosis of CS but has been found to have too low a diagnostic accuracy to be recommended [11].

Other Tests with Limited Evidence

• Loperamide test: There is insufficient evidence to support the use of this test for diagnosing CS [11].

It's essential to note that these obsolete tests were once considered relevant, but their accuracy and reliability have been questioned by more recent studies. The current diagnostic approach for Cushing's syndrome involves a combination of clinical evaluation, biochemical tests, and imaging studies.

Recommended Diagnostic Tests

• 24-hour urinary free cortisol test
• Late-night salivary cortisol test
• Overnight dexamethasone suppression test (DST)
• High-dose DST
• CRH stimulation test
• Bilateral inferior petrosal sinus sampling

These tests have been found to be more accurate and reliable in diagnosing Cushing's syndrome. However, it's crucial to consult the most recent guidelines and evidence-based recommendations for the most up-to-date information on diagnostic testing.

References:

[11] The diagnostic accuracy of various other tests previously advocated for the diagnosis of Cushing's syndrome (urinary 17-ketosteroids, 1600 h or other random cortisol levels, and the insulin tolerance test) is too low to recommend them for testing. [11] Other tests, such as the loperamide test, have insufficient evidence for their diagnostic accuracy.

Treatment Options for Obsolete Cushing's Syndrome

Cushing's syndrome, characterized by excessive adrenocortical steroid production, can be treated with various medications to manage the condition effectively. While surgical removal of the tumor is often considered the first-line treatment, drug therapy plays a crucial role in managing the disease, especially when surgery is not possible or has failed.

Medications Used in Cushing's Syndrome Treatment

Several medications have been developed to treat Cushing's syndrome, including:

• Ketoconazole: An antifungal medication that also inhibits cortisol production. It can be used as a first-line treatment for Cushing's disease and is effective in reducing cortisol levels [8].
• Metyrapone: A steroidogenesis inhibitor that blocks the conversion of cholesterol to cortisol, thereby reducing cortisol production.
• Osilodrostat: An 11-beta-hydroxylase inhibitor that specifically targets cortisol production. It has been approved by the FDA for the treatment of Cushing's disease in adults [6].
• Mitotane: A rare medication used to treat Cushing's syndrome, particularly when other treatments have failed.

Treatment Goals and Considerations

The primary goal of drug treatment in Cushing's syndrome is to reduce cortisol levels and alleviate symptoms. Treatment must be carefully managed to minimize the risk of permanent hormone deficiency and treatment-related side effects [15]. In some cases, medication may need to be adjusted or combined with other treatments to achieve optimal results.

Recent Advances in Drug Development

In recent years, there have been significant advances in drug development for Cushing's syndrome. New medications like osilodrostat have been approved, and existing ones have undergone reformulation to improve efficacy and safety [5].

References:

[1] - Context 2 [8] - Context 8 [6] - Context 6 [15] - Context 15

Differential Diagnosis of Obsolete Cushing's Syndrome

Cushing's syndrome, a condition characterized by excessive cortisol production, has been a topic of interest in the medical community for decades. However, with advancements in diagnostic techniques and understanding of the underlying mechanisms, some forms of Cushing's syndrome have become obsolete or less relevant.

Obsolescence of Certain Forms of Cushing's Syndrome

• Alcohol-induced pseudo-Cushing's disease: This condition was previously considered a differential diagnosis for Cushing's syndrome. However, with the development of more sensitive diagnostic tests, it is now recognized as a distinct entity (10).
• Metabolic syndrome X: This condition was once thought to be a possible cause of Cushing-like symptoms. However, further research has shown that it is not directly related to Cushing's syndrome (8).

Current Diagnostic Approaches

The diagnosis of Cushing's syndrome involves three steps: suspecting it on the basis of the patient's symptoms and signs, documenting the presence of hypercortisolism, and determining its cause. The evaluation to determine if the patient has hypercortisolism (Cushing syndrome) will be reviewed here.

• Urinary-free cortisol: This test is one of the four recommended initial screening tests for Cushing's syndrome (11).
• Late night salivary cortisol: This test is also used as an initial screening tool for Cushing's syndrome (11).

Conclusion

While certain forms of Cushing's syndrome have become obsolete, the diagnosis and differential diagnosis of this condition remain complex. The use of sensitive diagnostic tests and a thorough understanding of the underlying mechanisms are essential for accurate diagnosis and treatment.

References:

• [1] John Newell-Price, Peter Trainer, Michael Besser, Ashley Grossman, The Diagnosis and Differential Diagnosis of Cushing’s Syndrome and Pseudo-Cushing’s States, Endocrine Reviews, Volume 19, Issue 5, ...
• [2] The clinical recognition of Cushing's syndrome and its biochemical confirmation is a challenging problem. The best diagnostic approach to patients with suspected Cushing's syndrome is still evolving.
• [3] A straightforward approach to the differential diagnosis of Cushing's syndrome. Plasma ACTH must be measured by a 2-site immunometric assay (e.g., IRMA) and will reliably distinguish ACTH-dependent from ACTH-independent Cushing's syndrome.
• [4] To the Editor: The recent review article by Loriaux on the diagnosis of Cushing’s syndrome (April 13 issue) highlighted the importance of accurate diagnosis and differential diagnosis in clinical practice.
• [5] Diagnosis and Differential Diagnosis of Cushing's Syndrome N Engl J Med. 2017 Apr 13;376(15):1451-1459. doi: 10.1056/NEJMra1505550. Author D Lynn Loriaux 1 Affiliation 1 From the Division of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health and Science University, Portland.