Index. F Fatigue, 59 Food-dependent Cushing s syndrome, 286

Transcription

1 A Abdominal red striae, 57, 58 Aberrant hormone receptors, AIMAH familial forms, 215 investigative protocols, molecular mechanisms, 216, 217 paracrine mechanisms, 216 steroidogenesis, in vivo characterization, 219, 220 Acrochordons, 58 ACTH axis adrenal origin, Cushing s syndrome, Cushing s disease, ectopic Cushing s syndrome, 252 ACTH-dependent Cushing s syndrome differential diagnosis, ectopic Cushing s syndrome (see Ectopic ACTH syndrome (EAS)) etiologies, inferior petrosal sampling (see Inferior petrosal sinus adrenocorticotropic hormone sampling (IPSS)) MRI, scintigraphy, 92 ACTH-independent Cushing s syndrome, 81 vs. ACTH-dependent CS combined non-invasive strategies, CRH stimulation test, desmopressin stimulation test, 85 dynamic tests, 83 high-dose dexamethasone suppression test, adrenal cortical carcinomas (see Adrenal cortical carcinomas (ACC)) adrenocortical hyperplasias computed tomography (CT), 227 micronodular adrenal hyperplasias (MAHs), 226, 227 PPNAD, 226, 227 PRKAR1A mutations, 226, 228 bilateral macronodular hyperplasia (see ACTHindependent macronodular adrenal hyperplasia (AIMAH)) Cyclic AMP (camp), McCune Albright syndrome, 26 micronodular adrenocortical disease (MAD) McCune Albright syndrome, 231 PPNAD (see Primary pigmented nodular adrenocortical disease) primary pigmented nodular adrenal disease (PPNAD), 26 protein kinase A (PKA), serial analysis of gene expression (SAGE), ACTH-independent macronodular adrenal hyperplasia (AIMAH), 25 aberrant hormone receptors familial forms, 215 investigative protocols, molecular mechanisms, 216, 217 paracrine mechanisms, 216 steroidogenesis, in vivo characterization, 219, 220 clinical and laboratory features, cyclic Cushing s syndrome, 298 epidemiology, 210 genetic causes, 210 imaging, pathology, 212 pathophysiology aberrant hormone adrenal receptors, adrenal CS, angiotensin-responsive AIMAH, 215 catecholamine-responsive AIMAH, 214 GIP-dependent AIMAH, LH/hCG-responsive AIMAH, serotonin-responsive AIMAH, 215 vasopressin-responsive CS, 214 treatment, ACTH secretion. See Adrenocorticotropic hormone secretion Adrenal adenomas, 25, 26 Adrenal cortical carcinomas (ACC) ACTH receptor, 46 bimodal age distribution, 42 clinical presentation, comparative genomic hybridization analysis, 47 diagnosis, 194 dynamic tests, 195 epidemiology, 190 future aspects, 204 Gsa gene, 46 histopathological evaluation adults, pediatric group, Weiss criteria, 199 IGF system and locus 11p15, incidence, 41,

2 296 Adrenal cortical carcinomas (ACC) (continued) malignant cells, 49 medical therapy, microarray studies, 48 multiple endocrine neoplasia type I (MEN1), 46 N-ras activating mutation, 46 prognosis, 42 protein kinase C activity, 46 P53 tumor suppressor and locus 17p13, radiation therapy, 201 radiofrequency thermal ablation, 202 radiological investigation, CT scans, (18)-FDG positron emission tomography (PET), 198 MRI, sporadic adrenocortical tumor (see also Sporadic adrenocortical tumor) adult, 42 children, 44 staging systems, 200 steroidogenic factor 1 (SF 1), 48 surgery, 201 Wnt-β-Catenin pathway, Adrenal-directed treatment laparoscopic adrenalectomy, 131 advantages, 132 bilateral, efficacy of, 135 procedure, 134 risks of, 135 types of, 132 surgical approaches, 134 Adrenal incidentalomas, 26 Adrenal radiology CT, MRI, scintigraphy, adrenocortical tumors functional imaging modalities, 96 non-specific functional imaging modalities, 97 Adrenocortical carcinoma, 25 Adrenocortical hyperplasia computed tomography (CT), 227 McCune Albright syndrome, 231 micronodular adrenal hyperplasias (MAHs), 226, 227 PPNAD, 226, 227 PRKAR1A mutations, 226, 228 Adrenocorticotropic hormone (ACTH) secretion corticotrophin releasing hormone, 2 ectopic, 285 classification, 24 imaging, 97 scintigraphy, intracellular regulation, 4 microadenoma, 123, 124 negative feedback control, 7 8 pituitary directed treatment cyproheptadine, 154 dopamine agonists, peroxisome proliferator-activated receptor-γ, 153 retinoic acid, 154 ritanserin, 154 somatostatin analogues, Alcoholism, Aminoglutethimide, 156, 268 Angiotensin-responsive AIMAH, 215 B Bilateral adrenalectomy, 182. See also Adrenal-directed treatment laparoscopic treatment, 132 Nelson s syndrome (see Corticotroph tumor progression (CTP)) pituitary Nelson s tumors, 34 during pregnancy, 266 Bilateral inferior petrosal sinus sampling (BIPSS), 86 for ACTH, diagnostic work-up, Bilateral laparoscopic adrenalectomy, Bilateral macronodular hyperplasia. See ACTH-independent macronodular adrenal hyperplasia (AIMAH) Bone metabolism, 60, 61 Bromocriptine, 152 C Cabergoline, 152 camp. See Cyclic AMP Cardiovascular system, 59 Carney s complex (CNC), Catecholamine-responsive AIMAH, 214 Cavernous sinus, 143 Childhood, Cushing s syndrome. See Pediatric Cushing s syndrome (CS) Classic EAS, 164 Clinical settings, CS, CNC. See Carney s complex Computed tomography (CT), 227 Corticotrophin releasing hormone (CRH), 2 3 Corticotroph tumor progression (CTP) early detection, 181 evidence, after adrenalectomy, 180 pathophysiological hypotheses, pituitary MRI, 179 prediction, 181 pregnancy, 183 treatment, Corticotropic tumors animal models, CD canine CD, 31 equine CD, 31 genetically manipulated mammalian models, 32

3 297 hormonal and growth factor signals alteration, 33 transgenic oncogene overexpression, cell cycle regulators, genetic knockout, clinicopathological subtypes, 32 incidence, 31 molecular pathogenesis, 36 pathology active corticotroph adenomas, 34 clinically silent ACTH cell adenoma, 35 Crooke cell adenomas, 34 densely granulated ACTH adenoma cells, 34 extrapituitary parasellar corticotroph adenomas, 35 peritumoral non-adenomatous corticotroph cells, 35 pituitary Nelson s tumors, 34 pathophysiology, prevalence, 31 Corticotropin-releasing hormone (CRH), 123 Covert EAS, 24, 164 CRH. See Corticotropin-releasing hormone CT. See Computed tomography Cushing s syndrome, 132, 133, 135 Cyclic AMP (camp), Cyclic Cushing s syndrome clinical presentation, cyclic or periodic hypercortisolism, 284 diagnosis ACTH-independent hypercortisolism, 288 ACTH-independent macronodular adrenal hyperplasia, 289 dexamethasone suppression tests (DST), 287 mitral valve insufficiency and bleeding risk, 288 MRI, 288 positron emission tomography (PET), 288 scintigraphy with radionucleotide-labeled agonists, 288 urinary free cortisol levels (UFC), physiopathology corticosteroid-binding globulin (CBG) deficiency, 285 ectopic ACTH secretion, 285 food-dependent Cushing s syndrome, 286 pituitary apoplexy, 285 primary pigmented nodular adrenocortical disease, 286 urinary free cortisol (UFC), 285 therapy, Cyproheptadine, 268 D Depression, Dexamethasone suppression tests (DST), 167, 287 Dopamine agonists, E Ectopic ACTH syndrome (EAS), 24 25, 275 biochemical tests bilateral inferior petrosal sinus sampling (BIPSS), 167 biochemical markers, CRH stimulation test, highdose dexamethasone test (HDDST), 167 hypokalaemia, 168 low-dose dexamethasone test (LDDST), 167 whole-body venous catheterisation and sampling, 168 classic EAS, 164 clinical features, covert EAS, 164 CRH and ACTH secretion, 171 diagnosis, 166 differential diagnosis, 172 imaging, 97, 169 occult EAS, 164 overt EAS, 164 paraneoplastic EAS, 164 scintigraphy PET, somatostatin receptor scintigraphy, 97 signs and symptoms, 166 sources, treatment complementary therapy, medical therapy, 170 prognosis, 171 surgical approaches, 170 tumours associated, 165 Ectopic Cushing s syndrome. See also Adrenocorticotropic hormone (ACTH) secretion hypothalamo pituitary adrenal (HPA) axis recovery, 256 post-operative pituitary hormone replacement, 252 Electrolyte and water balance, 59 Endogenous Cushing s syndrome, 22, 80 Ethanol-induced pseudocushing, 70 Etomidate, 157 Exogenous Cushing s syndrome, F Fatigue, 59 Food-dependent Cushing s syndrome, 286 G Gamma Knife, 141, 142 Gastric inhibitory polypetide (GIP)-dependent AIMAH, Glucocorticoid resistance syndrome asthma GC resistance, auto-immune diseases, 242 clinical features, 237 diagnosis chronic fatigue, 243 considerations, 243 vs. Cushing s disease, BMD, 244

4 298 Glucocorticoid resistance syndrome (continued) hypercortisolism, 243 plasma ACTH and serum cortisol concentrations, 244 glucocorticoid receptor gene mutations, polymorphisms, hypothalamic-pituitary-adrenal (HPA)-axis, 236 leukemia inhibitory factor (LIF), 242 leukemic cell line, RU486 physiology, 237 treatment, unexplained glucocorticoid resistance ER22/23EK polymorphism, peripheral blood mononuclear leukocytes (PBMLs), 241 polymorphism (N766N), 241 Glucocorticoids (GC) a1-adrenergic receptors, 12 biological actions, 54 blood pressure, 11 catabolic changes, 13 hypothyroidism, 13 inflammatory response, osteoporotic fractures, 13 Glucose metabolism, 60 Glycoprotein hormone α-subunit (agsu) promoter, 33 Gonadal changes, 60 Growth retardation, H High dose dexamethasone suppression test (HDDST), 167, 277 Hypercortisolemia without Cushing s syndrome, 22 Hypercortisolism, β-HSD1, Cushing s syndrome, 10 glucocorticoids a1-adrenergic receptors, 12 blood pressure, 11 catabolic changes, 13 hypothyroidism, 13 inflammatory response, osteoporotic fractures, 13 GR binding sites and mrna expression, 11 increased plasma volume, 11 increased systemic vascular resistance, 11 obesity and growth retardation, 11 Hypothalamic pituitary adrenal (HPA) axis circadian rhythm, 5 6 glucocorticoid actions 11β-hydroxysteroid dehydrogenase (11β-HSD) enzymes, 9 10 corticosteroid-binding globulin, 9 gene expression, transcriptional regulation, 9 type I receptor, 8 type II receptor, 8 9 hypercortisolism (see Hypercortisolism) negative feedback control, 7 8 neuroendocrine control ACTH secretion, 3 5 corticotrophin releasing hormone (CRH), 2 3 proopiomelanocortin (POMC) gene transcription, 3 4 stress response, 6 7 Hypothalamo pituitary adrenal (HPA) axis recovery assessment of adrenal origin, Cushing s syndrome, Cushing s disease, ectopic Cushing s syndrome, 256 follow-up for relapse, 255 post-operative pituitary hormone replacement ACTH axis, pituitary hormones, Hypothyroidism, 13 I Immune system, Inferior petrosal sinus adrenocorticotropic hormone sampling (IPSS) ACTH and prolactin samples, 107 vs. cavernous sinus and jugular vein sampling, clinical evaluation, 115 corticotroph microadenoma, 105 vs. CRH stimulation test, vs. CT, 112 data interpretation, desmopressin, 113 differential diagnosis, vs. high-dose dexamethasone suppression (HDD), history, lateralization, 111 limitations and complications ectopic CRH, 114 episodic hypercortisolemia, 114 minor groin hematomas, pituitary venous drainage variability, 114 pseudo-cushing states, 114 thromboembolic complications, 115 vs. MRI, 112 percutaneous bilateral femoral approach, 107 pituitary microsurgery, 106 regression analysis, 111 venous drainage, anatomy, 107 K Ketoconazole, ,

5 299 L Laparoscopic adrenalectomy, 131 advantages, 132 bilateral, efficacy of, 135 procedure, 134 risks of, 135 types of, 132 Leukemia inhibitory factor (LIF), 33 LH/hCG-responsive AIMAH, Lipid metabolism, Low-dose dexamethasone suppression test (LDDST), 68, 167, 277 M Macroadenomas, 23 MAD. See Micronodular adrenocortical disease MAHs. See Micronodular adrenal hyperplasias McCune Albright syndrome (MAS), 231 AIMAH, 210, 212 etiology, 26 infancy, 274 Medical management agents blocking cortisol action, 157 drugs directed, adrenal agents inhibiting steroidogenesis, 155 aminoglutethimide, 156 etomidate, 157 ketoconazole, metyrapone, 155 mitotane, 156 trilostane, 157 monitoring of treatment, pituitary directed treatment, dopamine agonists, PPAR-γ receptor agonists, 153 retinoic acid, 154 somatostatin analogues, role of, therapy targets, 152 Metyrapone, 155, 267 Microadenomas, 23 Micronodular adrenal hyperplasias (MAHs), 226, 227 Micronodular adrenocortical disease (MAD) adrenocortical hyperplasia, McCune Albright syndrome, 231 PPNAD CNC, expressed genes, familial form, 230 genetics, MAD, pathways, Midnight serum/salivary cortisol, Mifepristone, 268 Mitotane, 156, 268 Muscle changes, 59 N Nelson s syndrome. See Corticotroph tumor progression (CTP) Neuroendocrine tumours (NETs) biochemical work-up, 168 clinical signs, 166 complementary therapy, 171 imaging, 169 medical therapy, 170 prognosis, 171 sources, 165 Neuropsychological changes, 59 O Obesity, buffalo hump appearance, 55, 56 grade III obesity, 55, 56 morbid obesity, 56 muscle atrophy, 55, 57 Occult EAS, 24, 164 Optic apparatus radiation effects, 143 Osteoporosis, 60, 61 Osteoporotic fractures, 13 Overt EAS, 24 Overweight. See Obesity P Paraneoplastic EAS, 164 Pediatric Cushing s syndrome (CS) adrenocortical tumors (ACT), 274 clinical assessment linear growth, puberty development, 276 Cushing s disease (CD), 275 ectopic ACTH syndrome (EAS), 275 investigation protocols ACTH-dependent or ACTH-independent, 276 adrenal imaging, 278 bilateral inferior petrosal sinus sampling for ACTH (BIPSS), CRH test, 276 high dose dexamethasone suppression test (HDDST), 277 low-dose dexamethasone suppression test (LDDST), 277 nodular adrenal hyperplasia, pituitary MR imaging, 278 urinary free cortisol (UFC), 276 McCune-Albright syndrome (MAS), 274 pituitary-dependent Cushing s disease (CD), 275 post-cure growth and development, 280 primary nodular adrenal hyperplasia, 275 treatments Cushing s disease, 279 pituitary radiotherapy, 280

6 300 Pediatric Cushing s syndrome (CS) (continued) primary adrenal lesions, 279 transsphenoidal surgery, Periodic hormonogenesis, 287 Peroxisome proliferator-activated receptor-γ (PPAR-γ), 153 Pituitary adenomas Cushing s disease, effectiveness of, radiosurgical modalities, Pituitary directed treatment dopamine agonists, PPAR-γ receptor agonists, 153 retinoic acid, 154 somatostatin analogues, Pituitary glands, 143 Pituitary hormones, Pituitary tumor transforming gene (PTTG), 34 PKA. See Protein kinase A Postoperative management, Post-operative pituitary hormone replacement ACTH axis adrenal origin, Cushing s syndrome, Cushing s disease, ectopic Cushing s syndrome, 252 pituitary hormones, PPAR-γ. See Peroxisome proliferator-activated receptor-γ PPNAD. See Primary pigmented nodular adrenocortical disease Pregnancy biochemical diagnosis assessment of 24 hour urinary free cortisol, 261, 263 dexamethasone suppression test, 263 midnight salivary cortisol, 263 clinical features, 260 etiology, hypothalamus-pituitary-adrenal axis, management bilateral adrenalectomy, 266 laparoscopic adrenalectomy, 267 medical treatment, radiotherapy, 267 transsphenoidal surgery, 266 unilateral adrenalectomy, 267 vs. non-pregnant state, 262 outcomes fetal outcomes, maternal morbidity, 265 Primary pigmented nodular adrenocortical disease (PPNAD), 26, 226, 227, 286 CNC, expressed genes, familial form, 230 genetics, MAD, pathways, PRKAR1A mutations, 226, 228 Proopiomelanocortin (POMC) gene transcription, 3 4 Protein kinase A (PKA), PseudoCushing conditions clinical assessment, 66 vs. Cushing s syndrome desmopressin test, 69 dexamethasone-suppressed CRH test, hexarelin, 69 insulin-induced hypoglycemia (ITT), 69 laboratorial diagnosis, Psychiatric changes, 59 R Radiation techniques, Radiation therapy. See Stereotactic radiosurgery Retinoic acid, 154 S SAGE. See Serial analysis of gene expression Scintigraphy ACTH-dependent Cushing s syndrome, 92 adrenocortical tumors functional imaging modalities, 96 non-specific functional imaging modalities, 97 ectopic ACTH syndrome PET, somatostatin receptor scintigraphy, 97 Serial analysis of gene expression (SAGE), Serotonin-responsive AIMAH, 215 Skin changes, Small cell lung carcinomas (SCLC) prevalence, 165 signs and symptoms, 166 Somatostatin analogues, Sporadic adrenocortical tumor ACTH receptor gene, 46 adult, 42 Arg337His mutation, p53, 45 children, 44 MEN1 gene, 46 11p15 locus, 47 17p13 LOH, 45 Stereotactic radiosurgery cavernous sinus, 143 complications of, 145 conventional radiation, 140 effectiveness of, pituitary adenomas, Gamma Knife, 141, 142 neuro-anatomical considerations, 143 normal pituitary gland, 143 optic apparatus radiation effects, 143 pituitary adenomas, planning and technique neuro-anatomical considerations, 143 treatment,

7 301 radiation techniques, radiosurgical modalities, pituitary tumors, treatment, Steroidogenesis regulation, Steroidogenic factor 1 (SF-1), 48 Sub-Clinical Cushing s syndrome (SCS), 26 Surgical management ACTH-secreting microadenoma, 123, 124 adrenocorticotropic hormone (ACTH) secretion, 121, 122 complications of, 126 corticotropin-releasing hormone (CRH), 123 postoperative management, postoperative recurrence of, 127 results of, surgical principles, surgical series of, technical aspects of, 125 T Takayasu s arteritis, 241 Thyroid gland, 61 Transsphenoidal pituitary surgery (TSS), Trilostane, 157 U Union International Contre Cancer (UICC) staging system, 200 Urinary free cortisol (UFC), 67 V Vasopressin-responsive CS, 214 W Wnt-β-Catenin pathway, 48 49