What is Itsenko Cushing Syndrome?

In 1924, the Soviet neurologist Nikolai Itsenko reported two patients with pituitary adenoma. The resulting excessive adrenocorticotropic hormone secretion led to the production of large amounts of cortisol by the adrenal glands.

How does Cushing’s syndrome cause hypernatremia?

Cortisol can also exhibit mineralocorticoid activity in high concentrations, worsening the hypertension and leading to hypokalemia (common in ectopic ACTH secretion) and hypernatremia (increased Na+ ions concentration in plasma).

How is pseudo Cushings treated?

The dexamethasone test uses a drug called dexamethasone which in normal people and those with pseudo-Cushings states, suppresses the production of ACTH by the pituitary leading to low cortisol levels.

Why does hypernatremia cause fluid overload?

Background. Hypervolemic hypernatremia is caused by an increase in total exchangeable Na+ and K+ in excess of an increment in total body H2O (TBW).

Can pseudo Cushings be cured?

This is called pseudo-Cushing state. Their high levels of cortisol and resulting Cushing-like symptoms can be reversed by treating whatever disease is causing the abnormal cortisol levels.

How is pseudo-Cushing’s diagnosed?

A midnight serum cortisol level of less than 7.5 µg/dL has 96% sensitivity and 100% specificity in differentiating pseudo-Cushing from true CS. Measurement of late-night salivary cortisol concentrations is increasingly used as a screening test in suspected CS.

How are plasma corticotropin levels related to Cushing’s syndrome?

Once Cushing’s syndrome has been diagnosed, the first step towards finding the cause is measuring plasma corticotropin concentrations. A concentration consistently below 1.1 pmol/L is classified as corticotropin-independent and does not lead to a diagnosis of Cushing’s disease.

What is the sensitivity of BIPSS for Cushing’s disease?

The BIPSS has a sensitivity and specificity of 94% for Cushing’s disease but it is usually used as a last resort due to its invasiveness, rare but serious complications, and the expertise required to perform it.

What is the mortality and morbidity of Cushing’s disease?

The mortality rate of Cushing’s disease was reported to be 10–11%, with the majority of deaths due to vascular disease Women aged 45–70 years have a significantly higher mortality rate than men. Moreover, the disease shows a progressive increase with time.

What are the symptoms of Cushing’s syndrome in children?

Glaucoma and cataracts also may occur in Cushing’s syndrome. In children, the two main symptoms are obesity and decreased linear growth. The clinical diagnosis must be based on the presence of one or more of the symptoms listed below because the syndrome itself has no true pathognomonic signs or symptoms.