Limitations of Basal Cortisol in the Diagnosis of Cushing Syndrome
ABSTRACT: Objective: Cushing syndrome (CS) is one of the most challenging diseases to diagnose due to the difficulties that may arise during laboratory test interpretations. A random serum cortisol level is often obtained by a general practitioner as a first step in the work-up of suspected CS patie...
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| Format: | Article |
| Language: | English |
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Elsevier
2019-03-01
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| Series: | AACE Clinical Case Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2376060520305174 |
| _version_ | 1818728273931141120 |
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| author | Amanda P.T. Barros, MD Elisa B. Lamback, MD Maria Caroline A. Coelho, MD, PhD Leonardo Vieira Neto, MD, PhD |
| author_facet | Amanda P.T. Barros, MD Elisa B. Lamback, MD Maria Caroline A. Coelho, MD, PhD Leonardo Vieira Neto, MD, PhD |
| author_sort | Amanda P.T. Barros, MD |
| collection | DOAJ |
| description | ABSTRACT: Objective: Cushing syndrome (CS) is one of the most challenging diseases to diagnose due to the difficulties that may arise during laboratory test interpretations. A random serum cortisol level is often obtained by a general practitioner as a first step in the work-up of suspected CS patients. In this respect, it is rarely useful and has limitations.Methods: We report an extremely unusual case of a female patient who presented with adrenocorticotropic hormone–independent CS and corticosteroid-binding globulin (CBG) deficiency.Results: The patient was initially misdiagnosed with and treated for adrenal insufficiency because of persistently low basal cortisol levels, in detriment of her exacerbated Cushing features and symptoms.Conclusion: We describe the limitations of using basal cortisol in the diagnosis of CS and review the differential diagnosis of patients with CS who have low basal cortisol. CBG variants may explain the findings of high urinary and salivary cortisol, in the absence of increased serum cortisol.Abbreviations: ACTH = adrenocorticotropic hormone; CBG = corticosteroid-binding globulin; CS = Cushing syndrome; RV = reference value |
| first_indexed | 2024-12-17T22:27:23Z |
| format | Article |
| id | doaj.art-4e720463fe284ac58147f0560e689b15 |
| institution | Directory Open Access Journal |
| issn | 2376-0605 |
| language | English |
| last_indexed | 2024-12-17T22:27:23Z |
| publishDate | 2019-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AACE Clinical Case Reports |
| spelling | doaj.art-4e720463fe284ac58147f0560e689b152022-12-21T21:30:18ZengElsevierAACE Clinical Case Reports2376-06052019-03-0152e91e94Limitations of Basal Cortisol in the Diagnosis of Cushing SyndromeAmanda P.T. Barros, MD0Elisa B. Lamback, MD1Maria Caroline A. Coelho, MD, PhD2Leonardo Vieira Neto, MD, PhD3From the Endocrinology Unit, Hospital Federal da Lagoa, Rio de Janeiro, Brazil; *Authors contributed equally to the manuscript.Department of Internal Medicine and Endocrine Unit, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; *Authors contributed equally to the manuscript.Department of Internal Medicine and Endocrine Unit, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Endocrinology Unit, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.Department of Internal Medicine and Endocrine Unit, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Address correspondence to Dr. Leonardo Vieira Neto, Department of Internal Medicine and Endocrine Unit, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, Ilha do Fundão, 21941-913, Rio de Janeiro/RJ, Brasil.ABSTRACT: Objective: Cushing syndrome (CS) is one of the most challenging diseases to diagnose due to the difficulties that may arise during laboratory test interpretations. A random serum cortisol level is often obtained by a general practitioner as a first step in the work-up of suspected CS patients. In this respect, it is rarely useful and has limitations.Methods: We report an extremely unusual case of a female patient who presented with adrenocorticotropic hormone–independent CS and corticosteroid-binding globulin (CBG) deficiency.Results: The patient was initially misdiagnosed with and treated for adrenal insufficiency because of persistently low basal cortisol levels, in detriment of her exacerbated Cushing features and symptoms.Conclusion: We describe the limitations of using basal cortisol in the diagnosis of CS and review the differential diagnosis of patients with CS who have low basal cortisol. CBG variants may explain the findings of high urinary and salivary cortisol, in the absence of increased serum cortisol.Abbreviations: ACTH = adrenocorticotropic hormone; CBG = corticosteroid-binding globulin; CS = Cushing syndrome; RV = reference valuehttp://www.sciencedirect.com/science/article/pii/S2376060520305174 |
| spellingShingle | Amanda P.T. Barros, MD Elisa B. Lamback, MD Maria Caroline A. Coelho, MD, PhD Leonardo Vieira Neto, MD, PhD Limitations of Basal Cortisol in the Diagnosis of Cushing Syndrome AACE Clinical Case Reports |
| title | Limitations of Basal Cortisol in the Diagnosis of Cushing Syndrome |
| title_full | Limitations of Basal Cortisol in the Diagnosis of Cushing Syndrome |
| title_fullStr | Limitations of Basal Cortisol in the Diagnosis of Cushing Syndrome |
| title_full_unstemmed | Limitations of Basal Cortisol in the Diagnosis of Cushing Syndrome |
| title_short | Limitations of Basal Cortisol in the Diagnosis of Cushing Syndrome |
| title_sort | limitations of basal cortisol in the diagnosis of cushing syndrome |
| url | http://www.sciencedirect.com/science/article/pii/S2376060520305174 |
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