Biology of Incretins: GLP-1 and GIP

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(14)61375-1.pdf

Cushing's syndrome

I. Introduction II. Definitions and Etiology III. Diagnostic Overview IV. Clinical Features V. Biochemical Diagnosis of Cushing’s Syndrome A. Cardinal features B. Urinary free cortisol (UFC) C. Low-dose dexamethasone testing D. Circadian rhythm assessment E. Cyclical Cushing’s syndrome VI. ACTH-Dependent vs. ACTH-Independent Cushing’s Syndrome VII. Differential Diagnosis of ACTH-Dependent Cushing’s Syndrome A. Overview B. Basal testing C. Dynamic noninvasive testing D. Invasive testing VIII. Other Causes of Cushing’s Syndrome IX. Imaging A. Pituitary B. Adrenal C. Ectopic secretion X. Differentiation from Pseudo-Cushing’s States XI. Conclusions

/pdf/the-diagnosis-and-differential-diagnosis-of-cushing-s-158bdip4c5.pdf

The Diagnosis and Differential Diagnosis of Cushing’s Syndrome and Pseudo-Cushing’s States

I. Introduction: The Adrenal Functional Unit II. Interaction Between Adrenal Medulla and Adrenal Cortex A. Relationship between medullary and cortical cells B. Paracrine control of adrenocortical function by the adrenal medulla C. Gap junctions in the adrenal cortex D. Summary III. Innervation of the Adrenal Cortex A. Evidence for a nerve supply to the adrenal cortex B. The source of adrenocortical innervation C. Regulation of adrenocortical innervation D. Role of the splanchnic nerve in regulating adrenocortical neural function E. Influence of adrenal innervation on adrenocortical function F. Effects of neurotransmitter substances on adrenocortical function G. Summary IV. The Vascular System of the Adrenal Gland A. Regulation of blood flow B. Relationship between blood flow and steroid secretion C. Effects of vascular endothelial cell products on steroid secretion D. Summary V. The Intraadrenal CRH/ACTH System A. Extrapituitary effect of CRH B. Intraadrenal ACTH C. Intraadrenal CRH and CRH receptors D. F...

Intraadrenal Interactions in the Regulation of Adrenocortical Steroidogenesis

Cushing's syndrome is usually caused by the secretion of corticotropin or cortisol by a pituitary or adrenal tumor, respectively, or by ectopic secretion of corticotropin. It is possible to determine the specific abnormality in most patients, but it can sometimes be difficult to decide whether the patient has hypercortisolism and whether it is primary or due to major depressive disorder or to the stress of other diseases. Determining the cause of the hypercortisolism involves performing multiple tests in a logical sequence; the results should all be consistent with the same diagnosis. Treatment should aim to cure the hypercortisolism and to eliminate any tumor that threatens the patient's health, while minimizing the chance of an endocrine deficiency or long-term dependence on medications.

Cushing's Syndrome

Background. Corticotropin-independent nodular adrenal hyperplasia is a rare cause of Cushing's syndrome, and the factors responsible for the adrenal hyperplasia are not known. Methods. We studied a 48-year-old woman with Cushing's syndrome, nodular adrenal hyperplasia, and undetectable plasma corticotropin concentrations in whom food stimulated cortisol secretion. Results. Cortisol secretion had an inverse diurnal rhythm in this patient, with low-to-normal fasting plasma cortisol concentrations and elevated postprandial cortisol concentrations that could not be suppressed with dexamethasone. The cortisol concentrations increased in response to oral glucose (4-fold increase) and a lipid-rich meal (4.8-fold increase) or a protein-rich meal (2.6-fold increase), but not intravenous glucose. The infusion of somatostatin blunted the plasma cortisol response to oral glucose. Intravenous infusion of gastric inhibitory polypeptide (GIP) for one hour increased the plasma cortisol concentration in the patie...

https://www.nejm.org/doi/pdf/10.1056/NEJM199210013271402

Gastric inhibitory polypeptide-dependent cortisol hypersecretion--a new cause of Cushing's syndrome.

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Gastric inhibitory polypeptide-dependent cortisol hypersecretion--a new cause of Cushing's syndrome.