title: A clinico-pathological study of Cushing's syndrome at the University Hospital of the West Indies and a review of the literature.
abstract: Cushing's syndrome is an uncommon but important disease. Twenty-one confirmed cases of spontaneous Cushing's syndrome were documented at the University Hospital of the West Indies over a 21-year period. They were predominantly young females (F:M ratio of 17:4; mean age 25 years and 3 months). The commonest presenting symptoms were amenorrhoea (41%) and obesity (19%). Common clinical features were cushingnoid features (95%), hypertension (76%) and hirsutism (82%). Twenty-nine per cent had frank hyperglycaemia. Cushing's syndrome was due to Cushing's disease in 10 cases, adrenal adenoma in 3 and adrenal carcinoma in 2 cases. In 4 cases with presumed adrenal hyperplasia, the histology was either unavailable or was not consistent with the diagnosis. Two cases appear now to have had the ectopic ACTH Syndrome. Adrenalectomy was the commonest treatment offered. There were no intra-operative or post-operative deaths but recurrence was common after subtotal adrenalectomy in Cushing's disease. Twenty-seven per cent of the patients developed Nelson's syndrome, which was fatal in 50%. Long-term hormone replacement therapy was unnecessary after surgery for adrenal adenomas. Treatment of Cushing's syndrome was well tolerated by the patients.
authors.affiliation: Departments of Medicine, Surgery, Radiology, Anaesthesia and Intensive Care, and Pathology, Faculty of Medical of Medical Sciences, University of the West Indies, Kingston 7, Jamaica.
authors.forename: R
authors.initials: R
authors.lastname: Wright-Pascoe
authors.forename: C F
authors.initials: CF
authors.lastname: Charles
authors.forename: R
authors.initials: R
authors.lastname: Richards
authors.forename: P
authors.initials: P
authors.lastname: Fletcher
authors.forename: B
authors.initials: B
authors.lastname: Hanchard
authors.forename: D
authors.initials: D
authors.lastname: Kelly
mesh_terms: D000182:ACTH Syndrome, Ectopic / Q000175:diagnosis; D000293:Adolescent; D000315:Adrenalectomy / Q000379:methods; D000328:Adult; D002648:Child; D003480:Cushing Syndrome / Q000150:complications / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D003907:Dexamethasone; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D009347:Nelson Syndrome / Q000209:etiology; D017678:Sex Distribution; D014900:West Indies
chemical_list: D003907:Dexamethasone