Diagnostic and Therapeutic Problems in Spontaneous Cushing's Syndrome: A Review with Five Case Reports

Abstract

Problems in diagnosis and therapy in Cushing's syndrome is discussed. Five typical cases (Cushing's disease 2; adrenal carcinoma 1; ectopic ACTH-syndrome 2) are presented. Steroid tests of value in the overall diagnosis of hypercorticism are estimations of basic values of 17-OHCS, 17-KGS, plasma cortisol and cortisol secretion rate. An absent C. R. of plasma cortisol and the increased adrenal response during the ACTH test is also of value; but the 1 mg-DST is probably the test of greatest reliability in the overall diagnosis. Although of only presumptive significance, the high dose DST of Liddle (1960), the metopirone test and the ACTH test is of great value in etiological diagnosis. Radiologic approach to adrenal disease, particularly selective angiography, is of supplementary diagnostic value.

In Cushing's disease total bilateral adrenalectomy is generally preferable to pituitary irradation. In adrenal carcinoma total adrenalectomy and/or treatment with o, p'-DDD may be of some benefit. In ectopic ACTH-syndrome about 10% can be cured by extirpation of a benign ACTH-producing tumour. In other cases total adrenalectomy or treatment with metopirone is only of palliative value.