{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:45:39Z","timestamp":1791909939736,"version":"4.3.4"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2007,9]]},"abstract":"<jats:p>\u2713 Endogenous Cushing syndrome (CS) results from hypercortisolemia caused by excess adrenocorticotropic hormone production in a pituitary adenoma or ectopic tumor, or by an adrenal tumor that directly produces excess cortisol. The diagnosis can usually be ascertained with a reasonable degree of certainty based on clinical and laboratory findings of hypercortisolism. There are patients, however, in whom the production of excess cortisol exhibits a cyclic or intermittent pattern, and, as a result, the clinical symptoms may be quite complex and varied. In these patients the hypothalamic-pituitary-adrenal axis may be normal between cycles, and dexamethasone suppression testing may produce a paradoxical response. In the present article, the authors provide a definition of cyclic Cushing syndrome, review the causes and its potential pathophysiological mechanisms, and discuss the treatment options based on a review of the available literature.<\/jats:p>","DOI":"10.3171\/foc.2007.23.3.5","type":"journal-article","created":{"date-parts":[[2008,1,24]],"date-time":"2008-01-24T07:25:20Z","timestamp":1201159520000},"page":"1-3","source":"Crossref","is-referenced-by-count":20,"title":["Cyclic Cushing syndrome: definitions and treatment implications"],"prefix":"10.3171","volume":"23","author":[{"given":"Dennis A.","family":"Velez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc R.","family":"Mayberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William H.","family":"Ludlam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-02300e4","series-title":"J Clin Endocrinol Metab","first-page":"320","article-title":"Cyclical Cushing's disease: two distinct rhythms in a patient with a basophil adenoma","volume":"60","author":"Atkinson","year":"1985"},{"key":"b2-02300e4","series-title":"Br Med J (Clin Res Ed)","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1136\/bmj.291.6507.1453","article-title":"Five cases of cyclical Cushing's syndrome","volume":"291","author":"Atkinson","year":"1985"},{"key":"b3-02300e4","series-title":"J Endocrinol Invest","first-page":"923","article-title":"Cyclical Cushing's disease and its successful control under sodium valproate","volume":"13","author":"Beckers","year":"1982"},{"key":"b4-02300e4","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","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","year":"1975"},{"key":"b5-02300e4","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","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","year":"1973"},{"key":"b6-02300e4","series-title":"Chest","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1378\/chest.124.4_MeetingAbstracts.304S","article-title":"Cyclic Cushings syndrome caused by periodic secretion of ACTH from a bronchial carcinoid tumor","volume":"124","author":"Frenia","year":"2003"},{"key":"b7-02300e4","series-title":"Exp Med Surg","first-page":"61","article-title":"The 17-ketosteroid excretion of a healthy man on weekdays and weekends","volume":"23","author":"Halberg","year":"1965"},{"key":"b8-02300e4","series-title":"Cancer","doi-asserted-by":"publisher","first-page":"2136","DOI":"10.1002\/1097-0142(19880515)61:10<2136::AID-CNCR2820611034>3.0.CO;2-P","article-title":"Oncocytic carcinoid of the kidney associated with periodic Cushing's syndrome","volume":"61","author":"Hannah","year":"1988"},{"key":"b9-02300e4","series-title":"J Endocrinol","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1677\/joe.0.0960401","article-title":"Effect of cyproheptadine, desmethylcyproheptadine, gamma-amino-butyric acid and sodium valproate on adrenocorticotrophin secretion by cultured pituitary tumor cells from three patients with Nelson's syndrome","volume":"96","author":"Lamberts","year":"1983"},{"key":"b10-02300e4","series-title":"Pituitary","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1007\/s11102-005-4025-5","article-title":"Cyclic Cushing's syndrome: an overview","volume":"7","author":"Mantero","year":"2004"},{"key":"b11-02300e4","series-title":"Eur J Edocrinol","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1530\/eje.0.1330313","article-title":"Long-distance and long-term follow-up of a patient with intermittent Cushing's disease by salivary cortisol measurements","volume":"133","author":"Mosnier-Pudar","year":"1995"},{"key":"b12-02300e4","series-title":"Endocr Rev","first-page":"647","article-title":"The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states","volume":"19","author":"Newell-Price","year":"1998"},{"key":"b13-02300e4","series-title":"J Clin Endocrinol Metab","first-page":"1163","article-title":"A single midnight serum cortisol measurement distinguishes Cushing's syndrome from pseudo-Cushing states","volume":"83","author":"Papanicolau","year":"1998"},{"key":"b14-02300e4","series-title":"J Clin Endocrinol Metab","first-page":"2681","article-title":"Late-night salivary cortisol as a screening test for Cushing's syndrome","volume":"83","author":"Raff","year":"1998"},{"key":"b15-02300e4","series-title":"Isr J Med Sci","first-page":"9191","article-title":"Cushing's syndrome associated with a bronchial adenoma. Possible periodic hormonogenesis","volume":"11","author":"Shapiro","year":"1975"},{"key":"b16-02300e4","series-title":"Q J Med","first-page":"351","article-title":"Variable hormonogenesis in Cushing's syndrome","volume":"79","author":"Shapiro","year":"1991"},{"key":"b17-02300e4","series-title":"J Endocrinol Invest","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1007\/BF03347794","article-title":"Cyclic Cushing's syndrome due to ectopic ACTH secretion by an adrenal pheochromocytoma","volume":"17","author":"Terzolo","year":"1994"},{"key":"b18-02300e4","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.1056\/NEJM198505233122102","article-title":"Evidence for two subtypes of Cushing's disease on the analysis of episodic cortisol secretion","volume":"312","author":"Van Cauter","year":"1985"},{"key":"b19-02300e4","series-title":"Horm Res","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1159\/000182169","article-title":"In vivo and in vitro studies in a patient with cyclical Cushing's disease showing some responsiveness to bromocriptine","volume":"36","author":"Watanobe","year":"1991"},{"key":"b20-02300e4","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.3171\/jns.1995.83.6.1087","article-title":"False-positive inferior petrosal sinus sampling in the diagnosis of Cushing's disease. Report of two cases","volume":"83","author":"Yamamoto","year":"1995"},{"key":"b1-02300e4","series-title":"J Clin Endocrinol Metab","first-page":"320","article-title":"Cyclical Cushing's disease: two distinct rhythms in a patient with a basophil adenoma","volume":"60","author":"Atkinson","year":"1985"},{"key":"b2-02300e4","series-title":"Br Med J (Clin Res Ed)","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1136\/bmj.291.6507.1453","article-title":"Five cases of cyclical Cushing's syndrome","volume":"291","author":"Atkinson","year":"1985"},{"key":"b3-02300e4","series-title":"J Endocrinol Invest","first-page":"923","article-title":"Cyclical Cushing's disease and its successful control under sodium valproate","volume":"13","author":"Beckers","year":"1982"},{"key":"b4-02300e4","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","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","year":"1975"},{"key":"b5-02300e4","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","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","year":"1973"},{"key":"b6-02300e4","series-title":"Chest","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1378\/chest.124.4_MeetingAbstracts.304S","article-title":"Cyclic Cushings syndrome caused by periodic secretion of ACTH from a bronchial carcinoid tumor","volume":"124","author":"Frenia","year":"2003"},{"key":"b7-02300e4","series-title":"Exp Med Surg","first-page":"61","article-title":"The 17-ketosteroid excretion of a healthy man on weekdays and weekends","volume":"23","author":"Halberg","year":"1965"},{"key":"b8-02300e4","series-title":"Cancer","doi-asserted-by":"publisher","first-page":"2136","DOI":"10.1002\/1097-0142(19880515)61:10<2136::AID-CNCR2820611034>3.0.CO;2-P","article-title":"Oncocytic carcinoid of the kidney associated with periodic Cushing's syndrome","volume":"61","author":"Hannah","year":"1988"},{"key":"b9-02300e4","series-title":"J Endocrinol","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1677\/joe.0.0960401","article-title":"Effect of cyproheptadine, desmethylcyproheptadine, gamma-amino-butyric acid and sodium valproate on adrenocorticotrophin secretion by cultured pituitary tumor cells from three patients with Nelson's syndrome","volume":"96","author":"Lamberts","year":"1983"},{"key":"b10-02300e4","series-title":"Pituitary","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1007\/s11102-005-4025-5","article-title":"Cyclic Cushing's syndrome: an overview","volume":"7","author":"Mantero","year":"2004"},{"key":"b11-02300e4","series-title":"Eur J Edocrinol","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1530\/eje.0.1330313","article-title":"Long-distance and long-term follow-up of a patient with intermittent Cushing's disease by salivary cortisol measurements","volume":"133","author":"Mosnier-Pudar","year":"1995"},{"key":"b12-02300e4","series-title":"Endocr Rev","first-page":"647","article-title":"The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states","volume":"19","author":"Newell-Price","year":"1998"},{"key":"b13-02300e4","series-title":"J Clin Endocrinol Metab","first-page":"1163","article-title":"A single midnight serum cortisol measurement distinguishes Cushing's syndrome from pseudo-Cushing states","volume":"83","author":"Papanicolau","year":"1998"},{"key":"b14-02300e4","series-title":"J Clin Endocrinol Metab","first-page":"2681","article-title":"Late-night salivary cortisol as a screening test for Cushing's syndrome","volume":"83","author":"Raff","year":"1998"},{"key":"b15-02300e4","series-title":"Isr J Med Sci","first-page":"9191","article-title":"Cushing's syndrome associated with a bronchial adenoma. Possible periodic hormonogenesis","volume":"11","author":"Shapiro","year":"1975"},{"key":"b16-02300e4","series-title":"Q J Med","first-page":"351","article-title":"Variable hormonogenesis in Cushing's syndrome","volume":"79","author":"Shapiro","year":"1991"},{"key":"b17-02300e4","series-title":"J Endocrinol Invest","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1007\/BF03347794","article-title":"Cyclic Cushing's syndrome due to ectopic ACTH secretion by an adrenal pheochromocytoma","volume":"17","author":"Terzolo","year":"1994"},{"key":"b18-02300e4","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.1056\/NEJM198505233122102","article-title":"Evidence for two subtypes of Cushing's disease on the analysis of episodic cortisol secretion","volume":"312","author":"Van Cauter","year":"1985"},{"key":"b19-02300e4","series-title":"Horm Res","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1159\/000182169","article-title":"In vivo and in vitro studies in a patient with cyclical Cushing's disease showing some responsiveness to bromocriptine","volume":"36","author":"Watanobe","year":"1991"},{"key":"b20-02300e4","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.3171\/jns.1995.83.6.1087","article-title":"False-positive inferior petrosal sinus sampling in the diagnosis of Cushing's disease. Report of two cases","volume":"83","author":"Yamamoto","year":"1995"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/23\/3\/foc.2007.23.3.5.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/23\/3\/foc.2007.23.3.5.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/23\/3\/foc.2007.23.3.5.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T08:51:52Z","timestamp":1780131112000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/23\/3\/foc.2007.23.3.5.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,9]]},"references-count":40,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/foc.2007.23.3.5","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,9]]}}}