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Midnight salivary cortisol, measured by highly sensitive electrochemiluminescence immunoassay, for the diagnosis of Cushing’s syndrome

100%
Yaneva M., Kirilov G., Zacharieva S.
Open Medicine
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2009
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vol. 4
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issue 1
59-64
EN
The aim of the present study is to evaluate the measurement of midnight salivary cortisol as a method of screening for Cushing’s syndrome (CS). Here we tested the performance of a highly sensitive electrochemiluminescence immunoassay (ECLIA) for midnight salivary cortisol measurement in an extensive clinical study (n=104). Three groups were investigated: 30 patients with CS, 34 with obesity and 40 healthy normal weight controls. All of them collected saliva samples at 24:00 h and urine samples over the same day (24 hour period). An electrochemiluminescence immunoassay was used to measure salivary cortisol. Mean midnight salivary cortisol in healthy volunteers, obese patients and patients with CS was 8.33 ± 3.62, 8.13 ± 4.47 and 33.11 ± 21.68 nmol/l, respectively. No significant difference was found between midnight salivary cortisol in healthy and obese subjects (P>0.05). In contrast, salivary cortisol at midnight was significantly higher in patients with CS (P<0.001) as compared to both other groups. The cut-off point of 14.2 nmol/l yielded a sensitivity of 93.3% and a specificity of 94.2% (AUCROC=0.984 ± 0.01(0.965-1.000). A strong positive correlation between midnight salivary cortisol and urinary free cortisol has been found in the CS group (r=0.686, P<0.0001). Our results demonstrate that measurement of midnight salivary cortisol could be successfully used as a first-line screening method for CS. Our data approve ECLIA as a simple, reliable and timesaving method for the assessment of salivary cortisol. Automated measurement of midnight salivary cortisol by ECLIA would facilitate the routine practice in the screening for CS.
2
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Clinical characteristics and follow-up of incidentally found adrenal tumours - results from a single tertiary centre

100%
Vasilev V., Matrozova J., Elenkova A., Zacharieva S.
Open Medicine
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2014
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vol. 9
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issue 2
292-301
3
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Triple negative breast cancer with ACTH-dependent Cushing's syndrome - case report

88%
Hodorowicz-Zaniewska D., Brzuszkiewicz K., Szpor J.
Polish Journal of Surgery
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2019
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vol. 91(2)
45-47
EN
Introduction: Endocrine and metabolic paraneoplastic syndromes in the course of malignant tumors result from ectopic production of hormones or hormone precursors in tumor cells. Production of hormones by endocrine tumors is relatively frequent, while such production by adenocarcinoma cells is definitely rare. The study presents a case of triple-negative invasive breast cancer, with the ectopic secretion of ACTH (adrenocorticotropic hormone), which provokes serious metabolic disorders. Materials and methods: The patient was admitted to hospital with symptoms of Cushing`s syndrome. Diagnostic tests revealed that the cause of metabolic disorders was breast cancer. After proper preparation, the patient was qualified for surgery. Results: After the mastectomy, the patient’s metabolism stabilized. The patient underwent adjuvant chemotherapy and radiotherapy. Four months after the last cycle of systemic treatment, cancer dissemination was found. The patient was treated with second-line chemotherapy, however, control CT revealed progression. The patient died 20 months after surgery and two months after the last cycle of chemotherapy. Conclusions: The case reported in this study – triple-negative invasive breast cancer, responsible for ectopic production of ACTH and causing Cushing’s syndrome – is a rare phenomenon. Treatment of patients with breast cancer showing hormonal activity should not differ from general rules applied for breast cancer. However, due to accompanying metabolic disturbances, the patients need individualized oncological approach, precise diagnostic tests, and adequate preoperative preparation.
4
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Incidentally detected adrenal tumors – characteristics of patients and incidence of hormonal disorders

51%
Grochoła I., Winder M., Kocot K., Menżyk T., Wojnar J.
Annales Academiae Medicae Silesiensis
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2019
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issue 73
74-80
EN
INTRODUCTION: Because of technological development and easier accessibility to diagnostic imaging, incidentally detected adrenal tumors are a frequently diagnosed endocrine disorder. The aim of the paper was to present the characteristics of patients with newly incidentally detected adrenal tumors, with emphasis on the detected hormonal disorders. MATERIAL AND METHODS: A retrospective, single center study included 96 patients hospitalized due to newly detected adrenal tumor between 2007 and 2014. RESULTS: Adrenal tumors were detected in 92 patients. The final diagnoses were: incidentaloma – 73 (76%), nodular adrenal hyperplasia – 12 (12.5%), pheochromocytoma – 5 (5.2%), late-onset congenital adrenal hyperplasia – 5 (5.2%), Conn’s syndrome – 1 (1.1%). In 94 out of the 96 patients at least one hormonal disorder was detected. The most frequent abnormalities were: incorrect plasma renin activity (67.7% of patients), evening serum cortisol concentration (60.2%, mean level: 8.9 µg%) and morning (48.9%, mean level: 15.4 µg%). A considerable group of patients suffered from comorbidities, such as hypertension (70.8%), impaired glucose tolerance (18.7%) and type 2 diabetes (16.7%). Additionally, the diameter of the tumors was negatively (p < 0.05) associated with the serum ACTH level. CONCLUSIONS: In most of the patients with incidentaloma, despite the lack of characteristic symptoms, it is possible to detect hormonal disorders in laboratory tests. The prevalence of hypertension and diabetes is high in this population of patients.
PL
WSTĘP: Wraz z gwałtownym postępem technicznym i zwiększoną dostępnością badań obrazowych przypadkowo wykryte guzy nadnerczy stały się częstym problemem endokrynologicznym. Celem pracy była charakterystyka pacjentów z przypadkowo wykrytymi guzami nadnerczy, ze szczególnym uwzględnieniem wykrywanych nieprawidłowości hormonalnych. MATERIAŁ I METODY: Retrospektywne jednoośrodkowe badanie objęło 96 pacjentów (21 mężczyzn i 75 kobiet w wieku 28–88 lat, mediana 62 lata), hospitalizowanych w latach 2007–2014 z powodu nowo wykrytych guzów nadnerczy. WYNIKI: Guzy nadnerczy zostały przypadkowo wykryte u 92 pacjentów. Po przeprowadzeniu diagnostyki rozpoznano: gruczolaki nadnercza – incydentaloma – w 73 przypadkach (76%), guzkowy przerost nadnerczy w 12 (12,5%), guzy chromochłonne w 5 (5,2%), późno wykryte wrodzone przerosty nadnerczy w 5 (5,2%) oraz zespół Conna w 1 przypadku (1,1%). Co najmniej jedno zaburzenie hormonalne wykryto u 94 spośród 96 pacjentów. Najczęstszymi zaburzeniami były: nieprawidłowa aktywność reninowa osocza (67,7% pacjentów), nieprawidłowe wieczorne stężenie kortyzolu (60,2%, średnie stężenie: 8,9 µg%) i poranne (48,9%, średnie stężenie: 15,4 µg%). Znaczna grupa pacjentów cierpiała na choroby współistniejące: nadciśnienie tętnicze (70,8%), nieprawidłową tolerancję glukozy (18,7%) i cukrzycę typu 2 (16,7%). Ponadto wykazano odwrotną korelację (p < 0,05) największego wymiaru guza ze stężeniem ACTH. WNIOSKI: U większości pacjentów z przypadkowo wykrytymi guzami nadnerczy, pomimo braku charakterystycznych objawów, można wykryć nieprawidłowości w badaniach hormonalnych. Nadciśnienie i cukrzyca występują u tych pacjentów częściej niż w populacji ogólnej.
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