ReviewThe Journal of physiology2015
Cushing's syndrome: from physiological principles to diagnosis and clinical care.
Review in The Journal of physiology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 60 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
60 citing papers in PubMed, 1 synthesis or guideline pooled it, 131 citations in OpenAlex.
- Plasma cortisol-linked gene networks in hepatic and adipose tissues implicate corticosteroid-binding globulin in modulating tissue glucocorticoid action and cardiovascular risk.Frontiers in endocrinology · 2023Pooled it
- Balancing inflammation under stress: glucocorticoid regulation of innate immune pathways.Bioscience reports · 2026Review
- Visualization of relative 11β-hydroxylase (CYP11B1) activity in human cortisol-producing adrenocortical adenoma (CPA) using mass spectrometry imaging-based enzyme histochemistry.Analytical and bioanalytical chemistry · 2026Article
- The identification of a PRKACA duplication at 19p13.12 in a female with PPNAD and thyroid carcinoma after a 20-year diagnostic journey.Familial cancer · 2026Article
- Cortisol measurement challenges in managing ectopic Cushing's syndrome with etomidate.Clinical chemistry and laboratory medicine · 2026Article
- Macrohormones in endocrinology: prevalence, clinical impact, and diagnostic approaches.Frontiers in endocrinology · 2026Review
- Crooke Cell Adenoma Presenting With Refractory Hypokalemia and Uncontrolled Hypertension.JCEM case reports · 2026Article
- "Feeding the Rhythm"-Effects of Food and Nutrients on Daily Cortisol Secretion: From Molecular Mechanisms to Clinical Impact.International journal of molecular sciences · 2025Review
- Long-term outcomes and survival predictors in patients with ectopic ACTH syndrome: data from a retrospective cohort study.Endocrine connections · 2025Article
- Article
- Critical Role for 24-Hydroxylation in Homeostatic Regulation of Vitamin D Metabolism.The Journal of clinical endocrinology and metabolism · 2025 · on this mapArticle
- False Positive Cushing's Syndrome in a 16-Year-Old Male.International journal of endocrinology and metabolism · 2025Article
- Case Report: Refractory hypokalemia as a clinical manifestation of Crooke's cell adenoma.Frontiers in medicine · 2025Article
- AS03-adjuvanted H5N1 vaccine enhances immune response by modulating NR4A1, SDC1, ID3 genes, and reducing cortisol.Human vaccines & immunotherapeutics · 2024Article
- Complicated iatrogenic Cushing's syndrome induced by topical clobetasol propionate in a child with psoriasis: a case report and review of the literature.Journal of medical case reports · 2024Review
- Improved Clinical Outcomes During Long-term Osilodrostat Treatment of Cushing Disease With Normalization of Late-night Salivary Cortisol and Urinary Free Cortisol.Journal of the Endocrine Society · 2024Article
- Current Challenges and Future Directions in the Assessment of Glucocorticoid Status.Endocrine reviews · 2024Review
- Reversible suppression of hypothalamo-pituitary-adrenal axis in Addison's disease due to ethinyl oestradiol-induced increase in total cortisol.Endocrinology, diabetes & metabolism case reports · 2024Article
- Ectopic adrenocortical adenoma characterized by hypogonadism: a case report and review of the literature.Journal of medical case reports · 2024Review
- Critical Role for 24-Hydroxylation in Homeostatic Regulation of Vitamin D Metabolism.medRxiv : the preprint server for health sciences · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The physiological control of cortisol synthesis in the adrenal cortex involves stimulation of adrenocorticotrophic hormone (ACTH) by hypothalamic corticotrophin-releasing hormone (CRH) and then stimulation of the adrenal by ACTH. The control loop of the hypothalamic-pituitary-adrenal (HPA) axis is closed by negative feedback of cortisol on the hypothalamus and pituitary. Understanding this system is required to master the diagnosis, differential diagnosis and treatment of endogenous hypercortisolism--Cushing's syndrome. Endogenous Cushing's syndrome is caused either by excess ACTH secretion or by autonomous cortisol release from the adrenal cortex. Diagnosis of cortisol excess exploits three physiological principles: failure to achieve the normal nadir in the cortisol diurnal rhythm, loss of sensitivity of ACTH-secreting tumours to cortisol negative feedback, and increased excretion of free cortisol in the urine. Differentiating a pituitary source of excess ACTH (Cushing's disease) from an ectopic source is accomplished by imaging the pituitary and sampling for ACTH in the venous drainage of the pituitary. With surgical removal of ACTH or cortisol-secreting tumours, secondary adrenal insufficiency ensues because of the prior suppression of the HPA axis by glucocorticoid negative feedback. Medical therapy is targeted to the anatomical location of the dysregulated component of the HPA axis. Future research will focus on new diagnostics and treatments of Cushing's syndrome. These are elegant examples of translational research: understanding basic physiology informs the development of new approaches to diagnosis and treatment. Appreciating pathophysiology generates new areas for inquiry of basic physiological and biochemical mechanisms.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.