STUDIES OF CUSHING'S DISEASE

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Determination of the underlying etiology of hypercortisolism is extremely challenging due to the nonspecificity of available tests. Consequently, the treatment currently offered for this highly morbid condition is unsuccessful in 20-25% of subjects. We propose that analysis of the 24 hour secretory profile of salivary cortisol, serum cortisol, and plasma ACTH will provide sensitive markers for the correct diagnosis of the etiology of hypercortisolism. In addition, sleep-disordered breathing (SDB) is common in subjects with Cushing s syndrome. It is unclear whether the SDB results from the associated obesity or whether there is a direct effect of the glucocorticoids on sleep centers. We hypothesize that (1) the use of salivary cortisol 24 hour profile as well as salivary response to CRF stimulation with or without dexamethasone is an accurate method of diagnosing Cushing s syndrome and (2) the correction of the hypercortisolism will improve the SDB seen in Cushing s syndrome.