A clinico-pathological study of two patients with Cushing's disease

The clinical and autopsy findings are described in two patients with Crushing's disease who died five days and 18 years following bilateral adrenalectomy. In each case tomography of the pituitary fossa was normal but examination of the pituitary revealed a 5 to 6 mm basophilic adenoma in the antero-inferior aspect of the gland. The first patient failed to show suppression of urinary oxogenic steroids during administration of high dose dexamethasone. The second patient had functioning adrenal autografts in skeletal muscle 18 years after adrenalectomy. The clinico-pathological correlation of these two patients supports modern re-emphasis on the aetiology of Cushing's disease as a primary pituitary tumour and its treatment by selective trans-sphenoidal hypophysectomy.