Patient case (clinical description): A 47-year-old man comes to the office due to weight gain and fatigue.  He is not able to lift heavy objects or climb stairs. Family history is positive for DM type 2 and HTN in his father.  Blood pressure is 165/90 mm Hg and pulse is 85/min.  On physical examination, there is symmetric proximal muscle weakness of the upper and lower extremities.  Fasting plasma glucose level is 138 mg/dL and 24-hour urinary cortisol is twice the upper normal limit.  Further evaluation reveals that high-dose, but not low-dose, dexamethasone suppresses serum cortisol levels.  Serum ACTH levels are high-normal. This patient's findings are consistent with endogenous Cushing Syndrome.

Patient's own account: I'm a 47-year-old man. I went to the clinic because I had been gaining weight and had increased fatigue over the past few weeks. I was not able to lift heavy objects or even climb the stairs. My dad was diagnosed with type 2 diabetes and high blood pressure. During the exam, they took my blood pressure, which was 165/90 mm Hg, and my pulse was 85/min. They found out that I have weaknesses in both of my arms and legs. I also did a blood test on an empty stomach, and I had a glucose level of 138 mg/dL, and twice the upper normal limit of cortisol. I had high-normal levels of ACTH. The doctor said I suffer from endogenous Cushing Syndrome.

Clinical trial: Hair Cortisol and Cushing's Disease

Eligibility criteria:
Inclusion Criteria:

        In the three groups:

          -  Age > 18

          -  Cushing's disease medical history: histology confirming an ACTH staining adenoma, or
             ACTH-dependant Cushing syndrome with MRI confirmation of pituitary adenoma, or
             pituitary secretion of ACTH confirmed with petrosal sinus gradient

          -  Written informed consent

          -  Hair length ≥ 3 cm

        In patient group:

          -  Persistent CD diagnosed on usual criteria in expert centers including overt
             hypercortisolism with at least 2 UFC > 1.5 N prior to the start of medical treatment

          -  Previous treatment with pasireotide, cabergoline, metyrapone, ketoconazole (alone or
             in association) AND hypercortisolism considered as controlled for at least 3 months
             based on 2 normal UFC.

        In remission control group:

        o Patients cured of CD and having recovered a normal pituitary function for at least 12
        months following pituitary surgery (normal UFC associated to: cortisol suppression
        following dexamethasone suppression test, or normal LNSC, or midnight serum cortisol < 200
        nmol/L)

        In bilateral surrenalectomy control group:

        o Patients with previous CD, treated with bilateral adrenalectomy and receiving weight
        adjusted doses of hydrocortisone for at least 6 months. Last daily dose of Hydrocortisone
        should be administered no later than 5 pm.

        Exclusion Criteria:

        In the three groups:

          -  Renal Failure (Cl < 30 mL/min)

          -  Non-compliant patients

          -  Hair length < 3 cm

          -  Severe depression and psychosis

          -  Drug addiction and active alcoholism

          -  Myocardial infarction or cerebrovascular accident < 3 months

          -  Intense physical activity (marathon runner)

          -  Night-shifters

          -  Obesity with BMI > 35 kg/m2

          -  Type 1 diabetes

          -  Type 2 diabetes with HbA1C > 9 %

        In patient group:

          -  Patients receiving mifepristone and/or mitotane

          -  Patients treated with anticortisolic agents during the titration process

          -  Patients requiring additional hydrocortisone supplementation or exogenous
             corticosteroids

          -  Pituitary radiotherapy < 5 years
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 18 Years old.


Eligibility (NLI label): Contradiction