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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">problendo</journal-id><journal-title-group><journal-title xml:lang="ru">Проблемы Эндокринологии</journal-title><trans-title-group xml:lang="en"><trans-title>Problems of Endocrinology</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">0375-9660</issn><issn pub-type="epub">2308-1430</issn><publisher><publisher-name>Endocrinology Research Centre</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.14341/probl13140</article-id><article-id custom-type="elpub" pub-id-type="custom">problendo-13140</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>Клиническая эндокринология</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>Clinical endocrinology</subject></subj-group></article-categories><title-group><article-title>Циклический синдром Кушинга: трудности диагностического поиска и выбора тактики лечения. Клинический случай</article-title><trans-title-group xml:lang="en"><trans-title>Cyclic Cushing’s syndrome: difficulties of diagnostic search and choice of treatment tactics. A clinical case</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0327-4619</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Дзеранова</surname><given-names>Л. К.</given-names></name><name name-style="western" xml:lang="en"><surname>Dzeranova</surname><given-names>L. K.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Дзеранова Лариса Константиновна – доктор медицинских наук.</p><p>Москва</p></bio><bio xml:lang="en"><p>Larisa K. Dzeranova - MD, PhD.</p><p>Moscow</p></bio><email xlink:type="simple">dzeranovalk@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-5724-6763</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Доровских</surname><given-names>А. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Dorovskikh</surname><given-names>A. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Доровских Анна Владимировна.</p><p>117036, Москва, ул. Дм. Ульянова, д. 11</p></bio><bio xml:lang="en"><p>Anna V. Dorovskikh – MD.</p><p>11 Dm. Ulyanova street, 117036 Moscow</p></bio><email xlink:type="simple">a.v.dorovskikh@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-6539-466X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Пигарова</surname><given-names>Е. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Pigarova</surname><given-names>E. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Пигарова Екатерина Александровна - доктор медицинских наук.</p><p>Москва</p></bio><bio xml:lang="en"><p>Ekaterina A. Pigarova - MD, PhD.</p><p>Moscow</p></bio><email xlink:type="simple">kpigarova@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4353-6705</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Лапшина</surname><given-names>А. М.</given-names></name><name name-style="western" xml:lang="en"><surname>Lapshina</surname><given-names>A. M.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Лапшина Анастасия Михайловна – кандидат медицинских наук.</p><p>Москва</p></bio><bio xml:lang="en"><p>Anastasia M. Lapshina - MD, PhD.</p><p>Moscow</p></bio><email xlink:type="simple">nottoforget@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7470-1676</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Воротникова</surname><given-names>С. Ю.</given-names></name><name name-style="western" xml:lang="en"><surname>Vorotnikova</surname><given-names>S. Y.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Воротникова Светлана Юрьевна - кандидат медицинских наук.</p><p>Москва</p></bio><bio xml:lang="en"><p>Svetlana Y. Vorotnikova - MD, PhD.</p><p>Moscow</p></bio><email xlink:type="simple">vorotnikova.s.y@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-0047-7223</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Шутова</surname><given-names>А. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Shutova</surname><given-names>A. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Шутова Александра Сергеевна.</p><p>Москва</p></bio><bio xml:lang="en"><p>Aleksandra S. Shutova - MD.</p><p>Moscow</p></bio><email xlink:type="simple">shutova.aleksandra@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-5824-6490</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Перепелова</surname><given-names>М. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Perepelova</surname><given-names>M. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Перепелова Маргарита Александровна.</p><p>Москва</p></bio><bio xml:lang="en"><p>Margarita A. Perepelova.</p><p>Moscow</p></bio><email xlink:type="simple">margo.doktor@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-9575-4520</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Григорьев</surname><given-names>А. Ю.</given-names></name><name name-style="western" xml:lang="en"><surname>Grigoriev</surname><given-names>A. Yu.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Григорьев Андрей Юрьевич - доктор медицинских наук.</p><p>Москва</p></bio><bio xml:lang="en"><p>Andrei Yu. Grigoriev - MD, PhD.</p><p>Moscow</p></bio><email xlink:type="simple">medway26@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-9718-6099</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Азизян</surname><given-names>В. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Azizyan</surname><given-names>V. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Азизян Вилен Неронович - кандидат медицинских наук.</p><p>Москва</p></bio><bio xml:lang="en"><p>Vilen N. Azizyan - MD, PhD.</p><p>Moscow</p></bio><email xlink:type="simple">vazizyan@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Национальный медицинский исследовательский центр эндокринологии</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Endocrinology Research Centre</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2023</year></pub-date><pub-date pub-type="epub"><day>25</day><month>02</month><year>2023</year></pub-date><volume>69</volume><issue>1</issue><fpage>8</fpage><lpage>14</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Дзеранова Л.К., Доровских А.В., Пигарова Е.А., Лапшина А.М., Воротникова С.Ю., Шутова А.С., Перепелова М.А., Григорьев А.Ю., Азизян В.Н., 2023</copyright-statement><copyright-year>2023</copyright-year><copyright-holder xml:lang="ru">Дзеранова Л.К., Доровских А.В., Пигарова Е.А., Лапшина А.М., Воротникова С.Ю., Шутова А.С., Перепелова М.А., Григорьев А.Ю., Азизян В.Н.</copyright-holder><copyright-holder xml:lang="en">Dzeranova L.K., Dorovskikh A.V., Pigarova E.A., Lapshina A.M., Vorotnikova S.Y., Shutova A.S., Perepelova M.A., Grigoriev A.Y., Azizyan V.N.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.probl-endojournals.ru/jour/article/view/13140">https://www.probl-endojournals.ru/jour/article/view/13140</self-uri><abstract><p>Циклический синдром Кушинга — патологическое состояние, для которого характерно чередование периодов ­избыточной секреции кортизола с соответствующими клиническими проявлениями и периодов спонтанной ремиссии заболевания.</p><p>Считается, что для установления диагноза эндогенного гиперкортицизма циклического течения необходимо зафиксировать не менее трех эпизодов чрезмерной секреции кортизола, сменяющихся периодами нормализации его продукции.</p><p>В большинстве случаев указанную патологию диагностируют у пациентов с АКТГ-секретирующей опухолью гипофиза, однако в литературе описаны редкие случаи циклической формы гиперкортицизма при наличии эктопированной секреции АКТГ опухолями разной локализации, а также без явной верификации очага патологической гормональной секреции. Кроме того, циклическая гиперпродукция кортизола может наблюдаться и при АКТГ-независимом синдроме Кушинга, ассоциированном с наличием кортикостеромы или гиперплазии надпочечников. Точные причины и механизмы циклического течения гиперкортицизма в настоящее время изучены недостаточно.</p><p>В связи с нетипичным течением заболевания, непредсказуемостью возникновения нового «цикла», вариабельностью его длительности и проявлений (не только у разных пациентов, но и у одного и того же пациента) верификация диагноза и определение тактики лечения могут быть затруднены в повседневной практике специалистов, а распространенность указанного состояния приуменьшена.</p></abstract><trans-abstract xml:lang="en"><p>Cyclic Cushing’s syndrome is a pathological condition characterized by alternating periods of excessive cortisol secretion with corresponding clinical manifestations and periods of spontaneous remission of the disease.</p><p>To diagnose Cyclic Cushing’s syndrome it is necessary to record at least three episodes of excessive cortisol secretion alternating with periods of normalization of its production.</p><p>In most cases, this pathology is diagnosed in patients with ACTH-secreting pituitary tumor, however, there are rare cases of cyclic hypercorticism with ectopic ACTH secretion by tumors of different localization and without verification of pathological hormonal secretion focus. In addition, cyclic hyperproduction of cortisol can be also observed in ACTH-independent Cushing’s syndrome associated with the presence of corticosteroma or adrenal hyperplasia. The exact causes and mechanisms of the cyclic hypercorticism are currently insufficiently studied.</p><p>Due to the atypical course of the disease, the unpredictability of the occurrence of a new «cycle», the variability of its duration and manifestations (not only in different patients, but also in the same patient), verification of the diagnosis and determination of treatment tactics may be difficult in the daily practice of specialists, and the prevalence of this condition can be undervalued.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>циклический синдром Кушинга</kwd><kwd>болезнь Иценко-Кушинга</kwd><kwd>эндогенный гиперкортицизм</kwd><kwd>АКТГ-эктопированный синдром</kwd></kwd-group><kwd-group xml:lang="en"><kwd>cyclic Cushing’s syndrome</kwd><kwd>endogenous hypercorticism</kwd><kwd>ACTH-ectopic syndrome</kwd></kwd-group></article-meta></front><back><ref-list><ref id="cit1"><element-citation><name><surname>BIRKE</surname> <given-names>GUNNAR</given-names> </name> <name><surname>DICZFALUSY</surname> <given-names>EGON</given-names> </name> <name><surname>PLANTIN</surname> <given-names>LARS-OLOF</given-names> </name> <article-title>FLUCTUATION IN THE EXCRETION OF ADRENOCORTICAL STEROIDS IN A CASE OF CUSHING's SYNDROME</article-title> <source>The Journal of Clinical Endocrinology &amp; 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