Overview
Cushing ulcer is not explicitly detailed in the provided abstracts; however, the context pertains to Cushing disease, a form of endogenous hypercortisolism resulting from a pituitary adenoma leading to excessive adrenocorticotropic hormone (ACTH) production 123.Diagnosis
Key Diagnostic Criteria: Elevated cortisol levels, often confirmed by late night salivary cortisol or urinary free cortisol (UFC) measurements 2.
Recommended Tests: Bilateral inferior petrosal sinus sampling for ACTH gradients to confirm pituitary origin 3.
Evaluation Challenges: Distinguishing remission from recurrence requires vigilant monitoring, with late night salivary cortisol being a sensitive early predictor of recurrence 2.Management
First-Line Treatments: Surgical resection of the pituitary adenoma is typically the primary approach 1.
Adjunctive Treatments:
- Steroidogenesis Inhibitors: Such as ketoconazole, metyrapone 1.
- Centrally Acting Agents: Including dopamine agonists like cabergoline 1.
- Glucocorticoid Receptor Antagonists: Mifepristone is an example 1.
Monitoring: Essential for optimizing clinical outcomes and managing adverse effects 1.Special Populations
No Specific Guidance Provided: The abstracts do not cover management specifics for pregnancy, pediatrics, elderly, or comorbidities 123.Key Recommendations
Regular Monitoring for Recurrence: Patients with Cushing disease should undergo lifelong monitoring for recurrence, utilizing late night salivary cortisol as an early indicator 2 (Evidence: Moderate).
Medical Therapy for Specific Scenarios: Use medical therapy preoperatively, post-radiotherapy, or in cases with uncertain tumor location to control hypercortisolism 1 (Evidence: Expert opinion).
Bilateral Inferior Petrosal Sinus Sampling for Diagnosis: Employ bilateral inferior petrosal sinus sampling for accurate diagnosis of Cushing disease, especially when confirming pituitary origin 3 (Evidence: Strong).References
1 Tritos NA, Biller BMK. Advances in the Medical Treatment of Cushing Disease. Endocrinology and metabolism clinics of North America 2020. link
2 Fleseriu M, Hamrahian AH, Hoffman AR, Kelly DF, Katznelson L. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY DISEASE STATE CLINICAL REVIEW: DIAGNOSIS OF RECURRENCE IN CUSHING DISEASE. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists 2016. link
3 Deipolyi AR, Hirsch JA, Oklu R. Bilateral inferior petrosal sinus sampling. Journal of neurointerventional surgery 2012. link
4 Rane SR, Deshmukh SD, Bapat VM. Amyloid (spheroid) deposits in pituitary adenoma presenting as Cushing disease--a case report. Indian journal of pathology & microbiology 2001. link