Brew Atkinson

Increased pressor response to noradrenaline in pituitary dependent Cushing's syndrome

The mechanism of hypertension in Cushings syndrome remains undetermined. Some studies have demonstrated an increased sensitivity to pressor agents but it is not clear if patients with Cushings syndrome of different aetiologies demonstrate this finding. We have examined pressor sensitivity in a group of patients with Cushings disease (pituitary dependent hypercortisolism) by measuring blood pressure during incrementally increasing infusions of noradrenaline.

What is the best approach to suspected cyclical Cushing syndrome? Strategies for managing Cushing’s syndrome with variable laboratory data

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. It is now being increasingly recognized. 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. The techniques and criteria, protocols and dynamic biochemical tools to detect cycling in patients with hypercortisolism are discussed as are the strategies for diagnosing and managing this important subgroup of patients with hypercortisolism.