Cushing's disease: dilemmas of diagnosis and management.
Determining the cause of Cushing's disease and correcting the abnormality presents a continuing challenge to the clinician despite remarkable advances in diagnostic and therapeutic techniques. We present seven cases to illustrate 1) the classic disorder cured by pituitary adenomectomy; 2) persistence of the disease after adenomectomy; 3) Cushing's disease manifesting in the puerperium and remitting with dopamine agonist therapy; 4) a patient whose disease relapsed at least five times during 20 years of treatment by adrenalectomy, pituitary radiation, mitotane, and pituitary adenomectomy; 5) the Nelson syndrome; 6) the ectopic adrenocorticotropic hormone (ACTH) syndrome in a patient with dexamethasone suppressible urinary cortisol who had a pituitary adenoma which stained positively for ACTH but who was not cured by total hypophysectomy; and 7) a patient whose ACTH-secreting tumor proved fatal despite repeated surgical, radiologic and pharmacologic measures.
Saeed-uz-Zafar
M
M
Division of Endocrinology and Metabolism, Henry Ford Hospital, Detroit, MI 48202.
Mellinger
R C
RC
Wisgerhof
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M
D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D003480:Cushing Syndrome / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006801:Humans; D007016:Hypophysectomy; D008297:Male; D009347:Nelson Syndrome / Q000209:etiology; D011644:Puerperal Disorders / Q000175:diagnosis; D012008:Recurrence
D000324:Adrenocorticotropic Hormone