81. Cushings Standards for Screening for Cushing's syndrome. INTRODUCTION. If cyclical Cushing'ssyndrome is suspected, repeat testing may be required on several occasions. http://www.acb.org.uk/welshaudit/cushings.htm

Standards for Screening for Cushing's Syndrome INTRODUCTION A survey of urine free cortisol measurements in use in Wales, presented at an audit meeting in May 1995, showed wide variations in practice and the need to review methods used for screening for Cushing's syndrome. A further survey on this latter topic was presented at another audit meeting in May 1996. The following standards are recommended in the light of the presentations and discussions at these meetings and consultation with the Welsh Endocrine and Diabetes Society. STANDARDS Patient Assessment The diagnosis or exclusion of Cushing's syndrome can be difficult and it is recommended that non-expert clinicians should seek the advice of a consultant physician or paediatrician with specialist endocrinology experience. Laboratory tests should not be used in isolation; results should be interpreted together with a full clinical assessment of the patient. Choice of Test First-line screening tests must have high sensitivity to minimise the incidence of false negative results and reference (cut-off) values chosen to achieve these aims. The overnight dexamethasone suppression test is particularly recommended, but 24 hour urine free cortisol determination is also suitable. Measurement of 9 am serum cortisol alone is not adequate. In many cases it is desirable to perform more than 1 test. If cyclical Cushing's syndrome is suspected, repeat testing may be required on several occasions.

82. CUSHING'S SYNDROME: THE FACTS YOU NEED TO KNOW CUSHING'S syndrome THE FACTS YOU NEED TO KNOW. Written by Paul Margulies,MD WHAT IS CUSHING'S syndrome? Cushing's syndrome is a disease http://www.medhelp.org/www/nadf4.htm

CUSHING'S SYNDROME: THE FACTS YOU NEED TO KNOW Written by: Paul Margulies, M.D., F.A.C.P., F.A.C.E. Medical Director - NADF Clinical Associate Professor of Medicine, Cornell University Medical College WHAT IS CUSHING'S SYNDROME? Cushing's Syndrome is a disease caused by an excess of cortisol production or by excessive use of cortisol or other similar steroid (glucocorticoid) hormones. Cortisol is a normal hormone produced in the outer portion, or cortex, of the adrenal glands, located above each kidney. The normal function of cortisol is to help the body respond to stress and change. It mobilizes nutrients, modifies the body's response to inflammation, stimulates the liver to raise the blood sugar, and it helps control the amount of water in the body. Another adrenal cortex hormone, aldosterone, regulates salt and water levels which affects blood volume and blood pressure. Small amounts of androgens (male hormones) are also normally produced in the adrenal cortex. Cortisol production is regulated by adrenocorticotrophic hormone (ACTH), made in the pituitary gland, which is located just below the brain. When too much cortisol is produced in the adrenal glands, or an excess is taken in treating other diseases, significant changes occur in all of the tissues and organs of the body. All of these effects together are called Cushing's Syndrome.

83. Cushing' Syndrome Laboratorial Diagnosis - Endocrinology - MEDSTUDENTS Karina Naomi Une Daniele de Menezes Ferreira. Medstudents' Homepage. Cushing'syndrome Laboratorial Diagnosis. Cushing’s syndrome. a) ACTH dependent. http://www.medstudents.com.br/endoc/endoc7.htm

Endocrinology Medstudents' Homepage Cushing' Syndrome Laboratorial Diagnosis Cushing’s Syndrome may be defined as a persistent and continuous state of endogenous cortisol overproduction, not being in accordance with ordinary circadian rhythm patterns (It was first fully clinically described by Harvey Cushing in 1912 .). As a consequence, it leads to various symptoms and signs, namely: Obesity (90%)* Hypertension (85%) Diminished Glucose Intolerance (80%) Sexual and menstrual dysfunction (76%) Hirsutism and acne (72%) * The main Cushing’s obesity feature is centripetal, but generalized obesity can occur - often to children. Apart from that, the finding of violet estriae, associated or not with the above characteristics, raises the suspicious of the syndrome. Also, it must be stressed out that the term "Cushing’s Disease" is a specific type of Cushing’s Syndrome whose ethiology is Pituitary Adenoma ACTH producer (generally it is due to microadenoma). The other types of Cushing Syndrome are classified according to the following: Cushing’s Syndrome a) ACTH dependent Macro and Microadenoma ACTH producing Pituitary;

84. Cushing's Syndrome Cushing's syndrome CAUSES OF CUSHING'S syndrome • Cushing's syndrome that resultsfrom high blood corticotropin (ACTH) levels • Cushing's syndrome that http://www.uptodate.com/patient_info/topicpages/topics/Endo_hor/6172.asp

Cushing's syndrome Weight gain Skin changes Menstrual irregularities Symptoms of androgen excess ... WHERE TO GET MORE INFORMATION Lynnette Kay Nieman, MD David N Orth, MD UpToDate performs a continuous review of over 290 journals and other resources. Updates are added as important new information is published. The literature review for UpToDate version 11.1 is current through December 2002; this topic was last changed on December 13, 2000. These materials are for your general information and are not a substitute for medical advice. You should contact your physician or other healthcare provider with any questions about your health, treatment, or care. Do not contact UpToDate or the physician authors of these materials. Weight gain Skin changes Menstrual irregularities Symptoms of androgen excess Muscle loss and weakness Bone loss Glucose intolerance Hypertension and cardiovascular disease Psychologic symptoms Infections Blood tests Computed tomography (CT) and magnetic resonance imaging (MRI) scans High-dose dexamethasone suppression test Scintigraphy Petrosal sinus sampling Levels of ACTH in blood from the petrosal sinuses are measured and compared with ACTH levels in a forearm vein. ACTH levels higher in the petrosal sinuses than in the forearm vein indicate the presence of a pituitary adenoma; similar levels at both locations suggest ACTH secretion by a non-pituitary tumor causing the ectopic ACTH syndrome.

85. Cushing's Disease Other sources of information on Cushing's disease www.canismajor.com/dog/cushings.html www.peteducation.com lbah.com/Canine/cushings.htm. http://www.voicenet.com/~howard/cushings.html

Home Message Board Scruffy's story Other dogs' stories ... e-mail me Cushing's Disease Have questions about Cushing's? Ask them on our new message board. Dr. J. M. Allen, a veterinarian in Monticello, KY, authored this information on Cushing's disease. Dr. Allen is a graduate of the Tennessee College of Veterinary Medicine and has more than 12 years experience in private practice including two years equine, one year small animal, and the rest in a general, mixed animal practice. More information on Dr. Allen and links to other information sources are at the end of this piece. Cushing's Disease, more properly known as Hyperadrenalcorticism, is a disease state caused by chronic excess levels of gluocorticoid (a type of steroid). Causes can include pituitary gland tumors, adrenal gland tumors, and the chronic injections of steroids. About 85% of all cases are due to tumors of the pituitary gland, which is located at the base of the brain. Signs of the disease are distended abdomen, thinning skin, loss of hair evenly over the body with a dry hair, darkening of the skin, the wasting away of muscle tissue and, in males, the shrinking of the testicles. Other signs are increased thirst and drinking of water, and chronic urinary tract infections. Breathing may be affected with an increase in panting. Affected animals may develop diabetes mellitus, which is often resistant to insulin. They may be weak and sleep most of the time. They may develop seizures or other nervous system changes.

86. NINDS Cushing's Syndrome Information Page More about Cushing's syndrome, Studies with patients, NINDS Cushing's syndromeInformation Page Synonym(s) Hypercortisolism Reviewed 0701-2001 http://www.ninds.nih.gov/health_and_medical/disorders/cushings_doc.htm

National Institute of Neurological Disorders and Stroke Accessible version Science for the Brain The nation's leading supporter of biomedical research on disorders of the brain and nervous system Browse all disorders Browse all health organizations More about Cushing's Syndrome Studies with patients Research literature Press releases Search NINDS... (help) Contact us My privacy NINDS is part of the National Institutes of Health NINDS Cushing's Syndrome Information Page Synonym(s): Hypercortisolism Reviewed 07-01-2001 Get Web page suited for printing Email this to a friend or colleague Table of Contents (click to jump to sections) What is Cushing's Syndrome? Is there any treatment? What is the prognosis? What research is being done? ... Organizations What is Cushing's Syndrome? Is there any treatment? Treatment of Cushing's syndrome depends on the cause of the overproduction of cortisol. If the cause is long-term use of a medication being used to treat another disorder, the physician may reduce the dosage until symptoms are under control. Surgery or radiotherapy may be used to treat pituitary adenomas. Surgery, radiotherapy, chemotherapy, immunotherapy, or a combination of these may be used to treat ectopic ACTH syndrome. The aim of treatment is to cure the hypercortisolism and to eliminate any tumor that threatens the individual's health, while minimizing the chance of endocrine deficiency or long-term dependence on medications. What is the prognosis?

87. Untitled This page is currently under repair. http://www.vetmed.auburn.edu/endo/faq.html

This page is currently under repair.

88. Cushing's Disease http://www.marvistavet.com/html/cushing_s_disease.html

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