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    ABSTRACT: Screening studies in high-risk populations have suggested that Cushing's syndrome is more common than previously appreciated. Patients who have specific signs and symptoms or clinical diagnoses known to be associated with hypercortisolism should be considered for screening. The measurement of late-night salivary cortisol provides the most sensitive method for screening, and urine-free cortisol and low-dose dexamethasone suppression testing may be used for confirmation of the diagnosis of endogenous hypercortisolism
    Endocrinology & Metabolism Clinics of North America 07/2005; 34(2):385-402, ix-x. DOI:10.1016/j.ecl.2005.02.001 · 2.86 Impact Factor
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    ABSTRACT: Predispositions to the superficial mycoses include warmth and moisture, natural or iatrogenic immunosuppression, and perhaps some degree of inherited susceptibility. Some of these infections elicit a greater inflammatory response than others, and the noninflammatory ones are generally more chronic. The immune system is involved in the defense against these infections, and cell-mediated immunity appears to be particularly important. The mechanisms involved in generating immunologic reactions in the skin are complex, with epidermal Langerhans cells, other dendritic cells, lymphocytes, microvascular endothelial cells, and the keratinocytes themselves all participating in one way or another. A variety of defects in the immunologic response to the superficial mycoses have been described. In some cases the defect may be preexistent, whereas in others the infection itself may interfere with protective cell-mediated immune responses against the organisms. A number of different mechanisms may underlie these immunologic defects and lead to the development of chronic superficial fungal infection in individual patients. Although the immunologic defects appear to be involved in the chronicity of certain types of cutaneous fungal infections, treatment of these defects remains experimental at the present time.
    Clinical Microbiology Reviews 08/1995; 8(3):317-35. · 16.00 Impact Factor
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    ABSTRACT: Pulmonary cryptococcosis was diagnosed by examining smears obtained by fine-needle aspiration (FNA) in a patient with pituitary Cushing's disease. FNA allowed for rapid diagnosis and prompt treatment of a potentially serious infection. The patient fully recovered from her pulmonary disease. Although opportunistic infections may occur in patients with endogenous Cushing's syndrome, it is rare to see such infections in the subset of patients with pituitary Cushing's disease. Hypercortisolism associated with Cushing's syndrome appears to induce a transitory immune deficiency state and opens a window of opportunity for certain infectious agents such as Cryptococcus neoformans to exploit. To our knowledge, this is the third such case reported in this clinical setting, and the first diagnosed by FNA.
    Diagnostic Cytopathology 06/1998; 18(5):365-7. DOI:10.1002/(SICI)1097-0339(199805)18:5<365::AID-DC13>3.0.CO;2-G · 1.52 Impact Factor