Cushing's disease. A review.
Cushing's syndrome continues to tax the most discerning clinician. I review pituitary-dependent adrenal hyperplasia (Cushing's disease), including recent experiences with Cushing's disease at Duke University, Durham, NC, and relate these observations to the current ideas as to pathophysiology, etiology, and management of Cushing's disease. Transsphenoidal microsurgery (TPS) performed by an experienced neurosurgeon offers selective removal of corticotropin (ACTH)-secreting adenoma, immediately cures the hypercortisolism, preserves pituitary function, and is associated with minimal morbidity. Postoperative hypoadrenalism appears to be the best marker of surgical cure. Transsphenoidal surgery has revolutionized our thoughts as to etiology and treatment of Cushing's disease, yet failures with TPS and uncertainty of recurrences leave room for radiotherapy, adrenalectomy, and adjunctive drug therapy in the management of this entity.
D000236:Adenoma / Q000150:complications / Q000601:surgery; D000293:Adolescent; D000315:Adrenalectomy; D000328:Adult; D000818:Animals; D001971:Bromocriptine / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D003480:Cushing Syndrome / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D003533:Cyproheptadine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007016:Hypophysectomy / Q000009:adverse effects; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000150:complications / Q000601:surgery; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects; D012008:Recurrence; D012110:Reserpine / Q000627:therapeutic use; D012658:Sella Turcica / Q000601:surgery; D014635:Valproic Acid / Q000627:therapeutic use
D003533:Cyproheptadine; D001971:Bromocriptine; D014635:Valproic Acid; D012110:Reserpine