{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T01:36:10Z","timestamp":1773365770659,"version":"3.50.1"},"reference-count":0,"publisher":"Oxford University Press (OUP)","issue":"5","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2009,11]]},"abstract":"<jats:sec><jats:title>Context<\/jats:title><jats:p>The hypothalamus\u2013pituitary\u2013thyroid axis in Cushing's syndrome may be altered. Previous reports have shown diminished serum TSH concentration and decreased response to TRH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>We analyzed serum TSH profiles in relation to cortisol profiles in patients with hypercortisolism of pituitary (<jats:italic>n<\/jats:italic>=16) or primary-adrenal origin (<jats:italic>n<\/jats:italic>=11) and after remission by pituitary surgery (<jats:italic>n<\/jats:italic>=7) in order to delineate aberrations in the hypothalamus\u2013pituitary\u2013thyroid system.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention<\/jats:title><jats:p>Patients and controls (<jats:italic>n<\/jats:italic>=27) underwent a 24-h blood sampling study. Serum TSH and cortisol were measured with precise methods, and data were analyzed with a deconvolution program, approximate entropy (ApEn), and cosinor regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Pulsatile TSH secretion and mean TSH pulse mass were diminished during hypercortisolism, independently of etiology (<jats:italic>P<\/jats:italic>&lt;0.001). TSH secretion was increased in patients in remission only during daytime due to increased basal secretion (<jats:italic>P<\/jats:italic>&lt;0.01). Pulse frequency and half life of TSH were similar in patients and controls. TSH ApEn (irregularity) was increased in patients with hypercortisolism (<jats:italic>P<\/jats:italic>&lt;0.01), but was normal in cured patients. Cross-ApEn between TSH and cortisol, a measure of pattern synchrony loss, was increased in active disease, indicating (partial) loss of secretory synchrony. The TSH rhythm was phase delayed in hypercortisolemic patients, but normal in cured patients (<jats:italic>P<\/jats:italic>&lt;0.01). Free thyroxine levels were decreased only in pituitary-dependent hypercortisolism compared with controls (<jats:italic>P<\/jats:italic>=0.003). Total 24-h TSH correlated negatively and linearly with log-transformed cortisol secretion (<jats:italic>R<\/jats:italic>=0.43, <jats:italic>P<\/jats:italic>=0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Cortisol excess decreases TSH secretion by diminishing pulsatile release, whereas surgically cured patients have elevated nonpulsatile TSH release. Diminished TSH secretory regularity in active disease suggests glucocorticoid-induced dysregulation of TRH or somatostatinergic\/annexin-1 control.<\/jats:p><\/jats:sec>","DOI":"10.1530\/eje-09-0580","type":"journal-article","created":{"date-parts":[[2009,8,18]],"date-time":"2009-08-18T01:32:54Z","timestamp":1250559174000},"page":"695-703","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":40,"title":["Diminished and irregular TSH secretion with delayed acrophase in patients with Cushing's syndrome"],"prefix":"10.1093","volume":"161","author":[{"given":"Ferdinand","family":"Roelfsema","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto M","family":"Pereira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nienke R","family":"Biermasz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marijke","family":"Frolich","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel M","family":"Keenan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes D","family":"Veldhuis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes A","family":"Romijn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","container-title":["European Journal of Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/eje.bioscientifica.com\/view\/journals\/eje\/161\/5\/695.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/eje.bioscientifica.com\/view\/journals\/eje\/161\/5\/695.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,14]],"date-time":"2023-02-14T16:23:53Z","timestamp":1676391833000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejendo\/article\/161\/5\/695\/6676387"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,11]]},"references-count":0,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.1530\/eje-09-0580","relation":{},"ISSN":["0804-4643","1479-683X"],"issn-type":[{"value":"0804-4643","type":"print"},{"value":"1479-683X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,11]]}}}