Friday, April 10, 2015

Cushing's Awareness: Relative Terms used to Define the "Severity" of Cushing's Disease

There are several terms floated about in the literature/research about Cushing's Disease which try to indicate the severity of the disease.  Here, I want to talk about and try to define the terms, then will later post about each so that I can talk about the research involved in each.

  1. Florid:  Also termed"classical", it 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 consensus on that in the literature and in the research.
  2. Cyclical:  This refers to elevated cortisol levels present at regular intervals.  The diurnal pattern is often reversed at regular intervals.   In Cyclic Cushing syndrome: definitions and treatment implications,  the authors state, "one will observe periodic episodes of “normal” test results. The duration of the cycles has been described as being 12 hours to 86 days".
  3. Subclinical:  This is defined by ACTH-induced mild hypercortisolism without typical features of Cushing’s disease, according to this Japanese research.
  4. Mild:  patients with Cushing’s syndrome whose cortisol tests were sometimes elevated and sometimes normal, according to this research.  Dr. Friedman, et al, believe episodic and mild Cushing's occur together.
  5. Episodic:  According to Friedman's research, linked above, episodic refers to "elevated cortisol levels occurring without any temporal pattern."

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