Cyclical Cushing's disease: report of a case cured by conventional cobaltotherapy

Preliminary hormonal studies in a 18-y old man with the clinical features of Cushing's syndrome showed inconclusive and conflicting results both in basal conditions and after metyrapone and dexamethasone administration. Therefore the possibility of a cyclical or acyclical fluctuation of adrenal hypersecretion was suspected and the patient was observed for an extended period of time free of hormonal manipulations. Regular cycles of cortisol hyperproduction, with peaks occurring every 6.0 days were found. Ectopic ACTH production was ruled out and, even in the absence of radiological evidence of a pituitary adenoma, conventional cobaltotherapy was suggested after refusal of transsphenoidal pituitary surgery. About 8 months later a marked clinical improvement was evident as well as normalization of hormonal data with loss of the cyclical pattern. Remission of the disease was still persistent 15 and 28 months later. A recent control, approximately 4 1/2 yr after treatment confirmed the normalization of biochemical data, suggesting a cure of the disease.