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Cushing's syndrome.

T A Howlett, L H Rees, G M Besser

Clinics in Endocrinology and Metabolism

|November 1, 1985

Summary

This summary is machine-generated.

Cushing's syndrome diagnosis and treatment are complex. Effective management strategies for pituitary, ectopic ACTH, and adrenal tumors vary, requiring precise diagnostic tools for optimal patient outcomes.

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Area of Science:

Endocrinology
Oncology
Neurosurgery

Background:

Cushing's syndrome presents significant clinical challenges.
Pituitary microadenomas are the most common cause of Cushing's disease.

Purpose of the Study:

To outline diagnostic and therapeutic approaches for Cushing's syndrome.
To differentiate between pituitary, ectopic ACTH, and adrenal causes.

Main Methods:

Trans-sphenoidal hypophysectomy for pituitary microadenomas.
Medical therapies (metyrapone, o,p'-DDD) and pituitary irradiation.
CT scanning and venous sampling for ectopic ACTH sources.
ACTH measurement and adrenal CT for adrenal tumors.

Main Results:

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Trans-sphenoidal hypophysectomy is effective for pituitary microadenomas.
Medical treatments induce remission but not cure; irradiation offers long-term cure in about half of cases.
Ectopic ACTH tumors require advanced imaging for localization and resection.
Adrenal adenomas are cured by adrenalectomy; carcinomas have a poor prognosis despite multimodal treatment.

Conclusions:

Accurate diagnosis is crucial for effective Cushing's syndrome management.
Treatment strategies must be tailored to the specific etiology (pituitary, ectopic, adrenal).
Surgical resection offers the best chance for cure in many cases, while other modalities manage persistent or advanced disease.