Abnormal puberty in paediatric Cushing's disease: relationship with adrenal androgen, sex hormone binding globulin and gonadotrophin concentrations. by Dupuis, C, Storr, H, Perry, L, Ho, J, Ahmed, L, Ong, K, Dunger, D, Monson, J, Grossman, AB, Besser, G, Savage, M

“…A4, DHEAS, T, SHBG, LH and FSH did not correlate with midnight cortisol, but A4 and T SDS correlated with ACTH at 09.00 h (both r = 0.51). …”

Is urinary free cortisol of value in the diagnosis of Cushing's syndrome? by Alexandraki, K, Grossman, AB

“…Biochemical tests are always needed to confirm the clinical suspicion: these include measurement of excess total endogenous cortisol secretion assessed by 24-h urinary free cortisol (UFC), loss of the normal feedback of the hypothalamo-pituitary-adrenal axis assessed by suppressibility after dexamethasone testing, and disturbance of the normal circadian rhythm of cortisol secretion assessed by midnight serum or salivary cortisol. This review focuses on recent data emerging on the value of UFC as a screening test for Cushing's syndrome. …”

Novel insights in the diagnosis of Cushing's syndrome. by Alexandraki, K, Grossman, AB

“…Many studies have examined the utility of resistance to steroid feedback by the dexamethasone suppression tests and increases in secretion assessing 24-hour urinary free cortisol; however, the most sensitive indicator is the loss of circadian rhythmicity. Therefore, midnight sleeping cortisol is undoubtedly an extremely sensitive indicator of CS but impractical for screening purposes. …”

Factors influencing skeletal maturation at diagnosis of paediatric Cushing's disease. by Peters, C, Ahmed, M, Storr, H, Davies, K, Martin, L, Allgrove, J, Grossman, AB, Savage, M

“…No relationships were found with midnight cortisol, ACTH, DHEA-S or cortisol suppression during the low-dose dexamethasone suppression test. …”

Differential diagnosis of adrenocorticotropic hormone-independent Cushing syndrome: role of adrenal venous sampling. by Martins, R, Agrawal, R, Berney, D, Reznek, R, Matson, M, Grossman, AB, Druce, MR

“…RESULTS: The patient reported a prior personal history of asthma, type 2 diabetes mellitus, hypertension, dyslipidemia, and bilateral leg ulcers, but she denied having any personal or family history of endocrinopathy and was not taking any corticosteroid medication. Elevated midnight serum cortisol, failure to suppress cortisol levels with a low-dose dexamethasone suppression test, and undetectable plasma ACTH all indicated ACTH-independent CS. …”

The differential diagnosis of Cushing's syndrome. by Newell-Price, J, Grossman, AB

“…A cortisol level below 50 nmol/l at midnight rules out active Cushing's syndrome with, in our experience, 100% sensitivity and a specificity depending on numerous other variables. …”

Long-term anterior pituitary function in patients with paediatric Cushing's disease treated with pituitary radiotherapy. by Chan, L, Storr, H, Plowman, P, Perry, L, Besser, G, Grossman, AB, Savage, M

“…Out of 12, 11 patients were cured by RT (cure interval 0.13-2.86 years) defined by mean serum cortisol of <150 nmol/l on 5-point day curve and midnight sleeping cortisol of <50 nmol/l. Long-term data are available for six male patients, who received RT at the age of 7.0-17.6 years. …”

Bone mineral density at diagnosis and following successful treatment of pediatric Cushing's disease. by Scommegna, S, Greening, J, Storr, H, Davies, K, Shaw, N, Monson, J, Grossman, AB, Savage, M

“…L2-L4 vBMD Z-score values correlated negatively with midnight cortisol (p < 0.05). In Group 2, mean L2-L4 vBMD was -0.38 (-1.0-0.13); and in 7/11, mean femoral neck (FN) areal (a)BMD Z-score was 0.14 (-1.62-2.46). …”

Clinical features, diagnosis, treatment and molecular studies in paediatric Cushing's syndrome due to primary nodular adrenocortical hyperplasia. by Storr, H, Mitchell, H, Swords, F, Main, K, Hindmarsh, P, Betts, P, Shaw, N, Johnston, D, Clark, A, Reznek, R, Grossman, AB, Savage, M

“…The diagnosis of CS was based on elevation of sleeping midnight serum cortisol and urinary free cortisol excretion, and impaired suppression of cortisol on both low- and high-dose dexamethasone suppression tests (DST). …”

How common are polycystic ovaries and the polycystic ovarian syndrome in women with Cushing's syndrome? by Kaltsas, G, Korbonits, M, Isidori, A, Webb, J, Trainer, P, Monson, J, Besser, G, Grossman, AB

“…The diagnosis of CS was based on the presence of appropriate clinical features and an elevated serum midnight cortisol with failure to suppress 0900 hours serum cortisol to less than 50 nmol/l following a formal low-dose dexamethasone suppression test (LDDST). …”

Cushing's disease in childhood: presentation, investigation, treatment and long-term outcome. by Savage, M, Lienhardt, A, Lebrethon, M, Johnston, L, Huebner, A, Grossman, AB, Afshar, F, Plowman, P, Besser, G

“…Cushing's disease was confirmed by detectable serum ACTH, median 28 ng/l (range 12-99, NR <10-50) (n = 15); loss of cortisol circadian rhythm values at midnight ranging from 216 to 1,080 nmol/l (NR <50) (n = 15); lack of cortisol suppression (NV < 50 nmol/l) during low-dose dexamethasone suppression test (LDDST) (0.5 mg 6-hourly x 8) (n = 14); and >50% suppression of cortisol compared with the basal value during high-dose dexamethasone suppression test (HDDST) (2 mg 6-hourly x 8) (n = 14). …”