CONTEXT: Facial plethora is a clinical sign described since ancient times for a variety of diseases. In the 19th century, it was linked to increased blood volume or flow, but this has never been proven. Facial plethora is also one of the earliest described clinical features of Cushing's syndrome (CS). OBJECTIVE: This study aimed to quantify facial plethora changes in CS as an early assessment of cure after surgery using noninvasive near-infrared multispectral imaging (MSI). DESIGN: The longitudinal cohort study was initiated in August 2012 and completed in August 2014. SETTING: Clinical research hospital, National Institutes of Health. PATIENTS: Thirty-four of the 38 patients who received surgical treatment for CS under protocol 97CH0076 during this period were included. INTERVENTION(S): MSI was performed on the right cheek of patients before surgery and 4.9 ± 3.1 days afterward. MAIN OUTCOME MEASURE(S): Average blood volume fraction as measured by MSI and serum cortisol. RESULTS: All but four of the 28 patients (86%) who were assessed as cured by postoperative plasma cortisol measurements of < 3 μg/dL showed a decrease in blood volume fraction (17.7 ± 0.03 vs 15.8 ± 0.03%; P = .0019), whereas an increase was seen in patients with persistent CS (18.5 ± 0.03 vs 21.4 ± 0.04%; P = .0017). Change in blood volume fraction before and after surgery was correlated with postoperative cortisol (rs = 0.58; P = .0003). CONCLUSIONS: Clinical data obtained from 34 patients indicate that a decrease in facial plethora after surgery, as evidenced by a decrease in blood volume fraction, is correlated with CS outcome. This novel technology for the first time identified a physiological mechanism associated with an ancient clinical sign. Furthermore, as a proof of principle, MSI is a promising early marker of cure in patients with CS that complements biochemical and clinical data.
CONTEXT: Facial plethora is a clinical sign described since ancient times for a variety of diseases. In the 19th century, it was linked to increased blood volume or flow, but this has never been proven. Facial plethora is also one of the earliest described clinical features of Cushing's syndrome (CS). OBJECTIVE: This study aimed to quantify facial plethora changes in CS as an early assessment of cure after surgery using noninvasive near-infrared multispectral imaging (MSI). DESIGN: The longitudinal cohort study was initiated in August 2012 and completed in August 2014. SETTING: Clinical research hospital, National Institutes of Health. PATIENTS: Thirty-four of the 38 patients who received surgical treatment for CS under protocol 97CH0076 during this period were included. INTERVENTION(S): MSI was performed on the right cheek of patients before surgery and 4.9 ± 3.1 days afterward. MAIN OUTCOME MEASURE(S): Average blood volume fraction as measured by MSI and serum cortisol. RESULTS: All but four of the 28 patients (86%) who were assessed as cured by postoperative plasma cortisol measurements of < 3 μg/dL showed a decrease in blood volume fraction (17.7 ± 0.03 vs 15.8 ± 0.03%; P = .0019), whereas an increase was seen in patients with persistent CS (18.5 ± 0.03 vs 21.4 ± 0.04%; P = .0017). Change in blood volume fraction before and after surgery was correlated with postoperative cortisol (rs = 0.58; P = .0003). CONCLUSIONS: Clinical data obtained from 34 patients indicate that a decrease in facial plethora after surgery, as evidenced by a decrease in blood volume fraction, is correlated with CS outcome. This novel technology for the first time identified a physiological mechanism associated with an ancient clinical sign. Furthermore, as a proof of principle, MSI is a promising early marker of cure in patients with CS that complements biochemical and clinical data.
Authors: Jana M Kainerstorfer; Franck Amyot; Martin Ehler; Moinuddin Hassan; Stavros G Demos; Victor Chernomordik; Christoph K Hitzenberger; Amir H Gandjbakhche; Jason D Riley Journal: J Biomed Opt Date: 2010 Jul-Aug Impact factor: 3.170
Authors: Abby Vogel; Victor V Chernomordik; Jason D Riley; Moinuddin Hassan; Franck Amyot; Bahar Dasgeb; Stavros G Demos; Randall Pursley; Richard F Little; Robert Yarchoan; Yang Tao; Amir H Gandjbakhche Journal: J Biomed Opt Date: 2007 Sep-Oct Impact factor: 3.170
Authors: Maya B Lodish; Ninet Sinaii; Nicholas Patronas; Dalia L Batista; Meg Keil; Jonelle Samuel; Jason Moran; Somya Verma; Jadranka Popovic; Constantine A Stratakis Journal: J Clin Endocrinol Metab Date: 2009-03-17 Impact factor: 5.958
Authors: D R McCance; D S Gordon; T F Fannin; D R Hadden; L Kennedy; B Sheridan; A B Atkinson Journal: Clin Endocrinol (Oxf) Date: 1993-01 Impact factor: 3.478
Authors: Dalia L Batista; Edward H Oldfield; Margaret F Keil; Constantine A Stratakis Journal: J Clin Endocrinol Metab Date: 2009-05-26 Impact factor: 5.958
Authors: M Paja; I Merlo; J Rodríguez-Soto; E Cruz-Iglesias; M D Moure; C Elías; A Oleaga; N Egaña Journal: J Endocrinol Invest Date: 2022-08-09 Impact factor: 5.467
Authors: Fabio R Faucz; Amit Tirosh; Christina Tatsi; Annabel Berthon; Laura C Hernández-Ramírez; Nikolaos Settas; Anna Angelousi; Ricardo Correa; Georgios Z Papadakis; Prashant Chittiboina; Martha Quezado; Nathan Pankratz; John Lane; Aggeliki Dimopoulos; James L Mills; Maya Lodish; Constantine A Stratakis Journal: J Clin Endocrinol Metab Date: 2017-08-01 Impact factor: 5.958
Authors: Grethe Å Ueland; Ralf Kellmann; Melissa Jørstad Davidsen; Kristin Viste; Eystein S Husebye; Bjørg Almås; Helen L Storr; Jørn V Sagen; Gunnar Mellgren; Petur B Júlíusson; Paal Methlie Journal: J Endocr Soc Date: 2021-03-04
Authors: Leah T Braun; Anna Riester; Andrea Oßwald-Kopp; Julia Fazel; German Rubinstein; Martin Bidlingmaier; Felix Beuschlein; Martin Reincke Journal: Front Endocrinol (Lausanne) Date: 2019-11-08 Impact factor: 5.555
Authors: Siddharth M Khare; Thien Nguyen; Afrouz A Anderson; Brian Hill; Roberto Romero; Amir H Gandjbakhche Journal: J Biomed Opt Date: 2020-11 Impact factor: 3.170