Thursday, April 12, 2012

Day 12 of the Cushing's Awareness Challenge: The Multiple Aliases of Cushing's

Episodic/intermittent/cylical/mild Cushing's has more aliases than a CIA operative. And I'm sure there are some I've left out. Since this form of Cushing's seems to be so elusive to the medical community, the analogy works extremely well. Episodic Cushing’s syndrome (CS) is a rare disorder, characterized by repeated episodes of cortisol excess interspersed by periods of normal cortisol secretion. The so-called cycles of hypercortisolism can occur regularly or irregularly with the phases ranging from days to years.

In comparison, "florid" or "classical" Cushing's shows evidence of continual or almost continual hypercortisolism. There is a school of thought which says these are really very rapidly cycling forms of Cushing's. However, there does not seem to be a concensus on that in the literature and in the research. Frankly, I don't know if anyone has done enough testing daily to figure it out.

According to some research done in the Netherlands, "As with classic hypercortisolism, cyclic CS is found more commonly among women than men, with a female to male ratio of 3:1 (Table 2). The disorder usually becomes manifest in the fifth decade, but may present from early infancy until older age (highest reported age at presentation being 72 years)."

Other clinical studies say, "The features of endogenous hypercortisolism (especially, when mild) are protean and coincide with many common clinical conditions like the dysmetabolic syndrome (1, 2). Screening studies in high-risk populations have discovered unsuspected CS in as many as 2–5% of patients with diabetes mellitus (3–7) and suggest that mild CS is more common than
previously appreciated
."

In Cyclical Cushing's syndrome: an update the full text article says, "Cyclical Cushing's syndrome is a pattern of hypercortisolism in which the biochemistry of cortisol production fluctuates rhythmically. This syndrome is often associated with fluctuating symptoms and signs. This type of case was initially thought to be rare. It has, however, recently been recognized as occurring much more frequently. The phenomenon is important because it can, if not recognized, lead to errors in diagnosis and differential diagnosis of the syndrome and in assessment of therapeutic outcomes. All of these can have very serious clinical consequences."

In High Prevalence of Normal Tests Assessing Hypercortisolism in Subjects with Mild and Episodic Cushing’s Syndrome Suggests that the Paradigm for Diagnosis and Exclusion of Cushing’s Syndrome  Requires Multiple Testing, "episodic hypercortisolism is highly prevalent in subjects with mild Cushing’s syndrome and no single test was effective in conclusively diagnosing or excluding the condition."

I was told by a prominent endocrinologist at a prominent teaching hospital that "cyclical Cushing's does not exist" and that I was "reading too much" when I was trying to get someone to help me. I hope this person is doing some more reading. S/he is not reading enough.

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