{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:46:53Z","timestamp":1791910013644,"version":"4.3.4"},"reference-count":37,"publisher":"BMJ","issue":"6507","license":[{"start":{"date-parts":[[1985,11,23]],"date-time":"1985-11-23T00:00:00Z","timestamp":501552000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br Med J (Clin Res Ed)"],"published-print":{"date-parts":[[1985,11,23]]},"abstract":"<jats:p>Reported cases of cyclical Cushing's syndrome are rare. Of 14 successive patients with Cushing's syndrome nine collected sequential urine samples for the estimation of cortisol:creatinine ratio. Five had cyclical Cushing's syndrome while two had considerable variation in urinary cortisol excretion without a cyclical pattern being established. Two of the five patients with a cyclical syndrome had paradoxical responses to dexamethasone. In only one patient with a cyclical pattern did the cortisol:creatinine ratio fall after treatment with bromocriptine or cyproheptadine, or both. The high incidence of the cyclical form of Cushing's syndrome has important clinical implications. A high index of suspicion of the syndrome is required in patients with symptoms or signs of Cushing's syndrome but with normal cortisol values, in patients with fluctuating cortisol values, and in patients with anomalous responses to dexamethasone. Because of possible variations in steroidogenesis the results of drug studies in Cushing's syndrome must be interpreted cautiously.<\/jats:p>","DOI":"10.1136\/bmj.291.6507.1453","type":"journal-article","created":{"date-parts":[[2009,4,2]],"date-time":"2009-04-02T11:00:59Z","timestamp":1238670059000},"page":"1453-1457","source":"Crossref","is-referenced-by-count":93,"title":["Five cases of cyclical Cushing's syndrome."],"prefix":"10.1136","volume":"291","author":[{"given":"A B","family":"Atkinson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A L","family":"Kennedy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D J","family":"Carson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D R","family":"Hadden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J A","family":"Weaver","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Sheridan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1985,11,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1210\/jcem-32-3-317","article-title":"Periodic hormonogenesis-a new phenomenon. Periodicity in function of a hormoneproducing tumour in man","volume":"32","author":"RE, I.Bailey","year":"1971","unstructured":"I Bailey RE. Periodic hormonogenesis-a new phenomenon. Periodicity in function of a hormoneproducing tumour in man. J Clin Endocrinol 1971;32:317-27.","journal-title":"J Clin Endocrinol"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1210\/jcem-36-3-445","article-title":"Cushing's disease with periodic hormonogenesis: one explanation for paradoxical response to dexamethasone","volume":"36","author":"Brown, R.D.; Van Loon, G.R.; Orth, D.N.; Liddle, G.W.","year":"1973","unstructured":"Brown RD, Van Loon GR, Orth DN, Liddle GW. Cushing's disease with periodic hormonogenesis: one explanation for paradoxical response to dexamethasone. 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Arch Intern Med 1976;136:441-43.","journal-title":"Arch Intern Med"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1210\/jcem-43-4-913","article-title":"Periodic remission in Cushing's disease with paradoxical dexamethasone response: an expression of periodic hormnonogenesis","volume":"43","author":"Liberman, B.; Waichenberg, B.L.; Tambascia, M.A.; Mesquita, C.H.","year":"1976","unstructured":"Liberman B, Waichenberg BL, Tambascia MA, Mesquita CH. Periodic remission in Cushing's disease with paradoxical dexamethasone response: an expression of periodic hormnonogenesis. 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West Med 1980;132:111-22.","journal-title":"West Med"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1210\/jcem-51-5-1195","article-title":"Twelve-hour cycles of adrenocorticotrophin and cortisol secretion in Cushing's disease","volume":"51","author":"Schteingart, D.E.; McKenzie, A.K.","year":"1980","unstructured":"Schteingart DE, McKenzie AK. Twelve-hour cycles of adrenocorticotrophin and cortisol secretion in Cushing's disease. Y Clin Endocrinol Metab 1980;51:1195-8.","journal-title":"Y Clin Endocrinol Metab"},{"key":"ref_9","first-page":"531","article-title":"Dynamics of adrenocorticotropin (ACTH) secretion in cyclic Cushing's syndrome: evidence for more than one abnormal ACTH biorhythm. J7 Clin Endocrinol Metab","volume":"55","author":"Jordan, R.M.; Ramos-Gabatin, A.; Kendall, J.W.; Gaudette, D.; Walls, R.C.","year":"1982","unstructured":"Jordan RM, Ramos-Gabatin A, Kendall JW, Gaudette D, Walls RC. Dynamics of adrenocorticotropin (ACTH) secretion in cyclic Cushing's syndrome: evidence for more than one abnormal ACTH biorhythm. J7 Clin Endocrinol Metab 1982;55:531-7."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/0026-0495(79)90097-0","article-title":"Cushing's syndrome: a review of diagnostic tests","volume":"28","author":"Crapo, L.","year":"1979","unstructured":"Crapo L. Cushing's syndrome: a review of diagnostic tests. Metabolism 1979;28:955-77.","journal-title":"Metabolism"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1093\/clinchem\/25.5.665","article-title":"A simple direct radioimmunoassay for plasma cortisol featuring a 1251 radioligand and a solid phase separation technique","volume":"25","author":"Riad-Fammy, D.","year":"1979","unstructured":"Riad-Fammy D, Read GF, Gaskell SJ, Dyas J, Hindawi R. 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J Clin EndocrinolMetab 1956;16:406-1 1.","journal-title":"J Clin EndocrinolMetab"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1530\/acta.0.0280163","article-title":"Fluctuating steroid excretion in Cushing's syndrome","volume":"28","author":"Bassoe, H.H.; Emberland, R.; Stoa, K.F.","year":"1958","unstructured":"Bassoe HH, Emberland R, Stoa KF. Fluctuating steroid excretion in Cushing's syndrome. Acta Endocninol Copenh 1958;28:163-8.","journal-title":"Acta Endocninol Copenh"},{"key":"ref_19","first-page":"336","article-title":"Cyclical Cushing's syndrome","volume":"i:","author":"Aber, C.P.; Cheetham, H.D.","year":"1961","unstructured":"Aber CP, Cheetham HD. Cyclical Cushing's syndrome. BrMedJ 1961;i:336-8.","journal-title":"BrMedJ"},{"key":"ref_20","first-page":"1138","article-title":"Severe osteopenia in young adults associated with Cushing's syndrome due to micronodular hyperplasia","volume":"39","author":"Ruder, H.J.; Loriaux, D.L.; Lipsett, M.B.","year":"1974","unstructured":"Ruder HJ, Loriaux DL, Lipsett MB. Severe osteopenia in young adults associated with Cushing's syndrome due to micronodular hyperplasia.J C\/in EndocnnolMezab 1974;39: 1138-47.","journal-title":"J C\/in EndocnnolMezab"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1210\/jcem-40-4-659","article-title":"Spontaneous remission of Cushing's syndrome in a patient with an adrenal adenoma","volume":"40","author":"Blau, N.; Miller, W.E.; Miller, E.R.; Cervi-Skinner, S.J.","year":"1975","unstructured":"Blau N, Miller WE, Miller ER, Cervi-Skinner SJ. Spontaneous remission of Cushing's syndrome in a patient with an adrenal adenoma. 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Am 7 Med 1979;69:507-10.","journal-title":"Am 7 Med"},{"key":"ref_24","first-page":"53","article-title":"Intermittent Cushing's syndrome with anomalous response to dexamethasone","volume":"36","author":"Brooks, R.V.; Jeffcoate, S.L.; London, D.R.; Prunty, F.I.G.; Smith, P.M.","year":"1966","unstructured":"Brooks RV, Jeffcoate SL, London DR, Prunty FIG, Smith PM. Intermittent Cushing's syndrome with anomalous response to dexamethasone. Y Endocrtnol 1966;36:53-61.","journal-title":"Y Endocrtnol"},{"key":"ref_25","first-page":"61","article-title":"The 17-ketosteroid excretion of a healthy man on weekdays and weekends","volume":"23","author":"Halberg, F.; Engeli, M.; Hamburger, C.","year":"1965","unstructured":"Halberg F, Engeli M, Hamburger C. The 17-ketosteroid excretion of a healthy man on weekdays and weekends. Exp Med Surg 1965;23:61-69.","journal-title":"Exp Med Surg"},{"issue":"12","key":"ref_26","first-page":"205","article-title":"Subclinical adenoma of the pituitary gland","volume":"1936","author":"Costello, R.T.","unstructured":"Costello RT. Subclinical adenoma of the pituitary gland. Am] Pawhol 1936;12:205-15.","journal-title":"Am] Pawhol"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1056\/NEJM198101153040306","article-title":"Microadenomas of the pituitary and abnormal sellar tomograms in an unselected autopsy series","volume":"304","author":"Burrow, G.N.; Wortzman, G.; Rewcastle, N.B.; Holgate, R.C.; Kovacs, K.","year":"1981","unstructured":"Burrow GN, Wortzman G, Rewcastle NB, Holgate RC, Kovacs K. Microadenomas of the pituitary and abnormal sellar tomograms in an unselected autopsy series. N Engl J Med 1981;304:156-8.","journal-title":"N Engl J Med"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"949","DOI":"10.7326\/0003-4819-90-6-949","article-title":"Bromocriptine and endocrine disorders","volume":"90","author":"Spark, R.F.; Dickstein, G.","year":"1979","unstructured":"Spark RF, Dickstein G. Bromocriptine and endocrine disorders. Ann Intern Med 1979;90:949-56.","journal-title":"Ann Intern Med"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1210\/jcem-51-2-307","article-title":"The mechanism of the suppressive action of bromocriptine on adrenocorticotropin secretion in patients with Cushing's disease and Nelson's syndrome","volume":"51","author":"Lamberts, S.W.J.; Klijn, J.G.M.; De Quijada, M.","year":"1980","unstructured":"Lamberts SWJ, Klijn JGM, De Quijada M, et al. The mechanism of the suppressive action of bromocriptine on adrenocorticotropin secretion in patients with Cushing's disease and Nelson's syndrome. ] Clin Endocrtnol Metab 1980;51:307-11.","journal-title":"Clin Endocrtnol Metab"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1530\/acta.0.0890461","article-title":"ACTH and cortisol response to bromocriptine, and results of long-termn therapy in Cushing's disease","volume":"89","author":"Kennedy, A.L.; Sheridan, B.; Montgomery, D.A.D.","year":"1978","unstructured":"Kennedy AL, Sheridan B, Montgomery DAD. ACTH and cortisol response to bromocriptine, and results of long-termn therapy in Cushing's disease. Acta Endocrinol Copenh 1978;89:461-8.","journal-title":"Acta Endocrinol Copenh"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1056\/NEJM197510302931802","article-title":"Cyproheptadine-induced remission of Cushing's disease","volume":"293","author":"Krieger, D.T.; Amorosa, L.; Linick, F.","year":"1975","unstructured":"Krieger DT, Amorosa L, Linick F. Cyproheptadine-induced remission of Cushing's disease. N Engli] Med 1975;293:893-6.","journal-title":"N Engli] Med"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1136\/adc.54.6.466","article-title":"Cushing's disease presenting with growth failure: clinical remission during cyproheptadine therapy","volume":"54","author":"Grant, D.B.; Atherden, S.M.","year":"1979","unstructured":"Grant DB, Atherden SM. Cushing's disease presenting with growth failure: clinical remission during cyproheptadine therapy. Arch Dis Child 1979;54:466-8.","journal-title":"Arch Dis Child"},{"key":"ref_33","first-page":"77","article-title":"Cyproheptadine in the control of Cushing's disease","volume":"149","author":"Hsu, T.; Gann, D.S.; Tsan, K.; Russell, R.P.","year":"1981","unstructured":"Hsu T, Gann DS, Tsan K, Russell RP. Cyproheptadine in the control of Cushing's disease. Johns Hopkins MedicalJournal 1981;149:77-83.","journal-title":"Johns Hopkins MedicalJournal"},{"key":"ref_34","article-title":"Accepted","year":"1985","unstructured":"(Accepted 27 September 1985)"},{"key":"ref_35","article-title":"syndrome in patients who were sensitive to steroids and had frequent relapses.'\"","volume-title":"the gonadal toxicity of this drug was not appreciated.4 Subsequent reports, however, have suggested a significant inverse correlation of sperm density with cyclophosphamide dosage","year":"1972","unstructured":"syndrome in patients who were sensitive to steroids and had frequent relapses.'\" Until 1972 the gonadal toxicity of this drug was not appreciated.4 Subsequent reports, however, have suggested a significant inverse correlation of sperm density with cyclophosphamide dosage."},{"key":"ref_36","article-title":"Men who were aged 17 or older in 1983 and had been treated with cyclophosphamide for childhood nephrotic syndrome at The Hospital for Sick Children, Toronto, between 1967 and 1976 were considered eligible for this study. Of 70 such patients, 28 were unavailable, two had died in motor vehicle accidents, seven refused to participate, and 33 were included in the study. Three patients were subsequently excluded from analysis owing to chronic renal failure (two patients) or a single testis","unstructured":"Men who were aged 17 or older in 1983 and had been treated with cyclophosphamide for childhood nephrotic syndrome at The Hospital for Sick Children, Toronto, between 1967 and 1976 were considered eligible for this study. Of 70 such patients, 28 were unavailable, two had died in motor vehicle accidents, seven refused to participate, and 33 were included in the study. Three patients were subsequently excluded from analysis owing to chronic renal failure (two patients) or a single testis (one patient)."},{"key":"ref_37","article-title":"When reviewed in 1983 all 30 patients were well and free of oedema. The three who had focal segmental glomerulosclerosis continued to have proteinuria with no clinical evidence of nephrosis or serious renal impairment. Two of the six patients with minimal lesions who relapsed after","unstructured":"When reviewed in 1983 all 30 patients were well and free of oedema. The three who had focal segmental glomerulosclerosis continued to have proteinuria with no clinical evidence of nephrosis or serious renal impairment. Two of the six patients with minimal lesions who relapsed after"}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.291.6507.1453","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.291.6507.1453","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T19:26:12Z","timestamp":1765481172000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.291.6507.1453"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1985,11,23]]},"references-count":37,"journal-issue":{"issue":"6507","published-online":{"date-parts":[[1985,11,23]]},"published-print":{"date-parts":[[1985,11,23]]}},"alternative-id":["10.1136\/bmj.291.6507.1453"],"URL":"https:\/\/doi.org\/10.1136\/bmj.291.6507.1453","relation":{},"ISSN":["0267-0623","1468-5833"],"issn-type":[{"value":"0267-0623","type":"print"},{"value":"1468-5833","type":"electronic"}],"subject":[],"published":{"date-parts":[[1985,11,23]]}}}