[Special diagnosis in Cushing's syndrome]

The diagnostic results in 32 patients (23 female, 9 male) with Cushing's syndrome are presented. 20 patients had pituitary Cushing's syndrome (mean age 36.2 +/- 15.9 years), 7 unilateral adrenal adenoma (mean age 37.1 +/- 15.3 years) and 4 (mean age 54.8 +/- 10.8 years) carcinoma of one adrenal gland. One patient had an ectopic ACTH syndrome based on a Zollinger-Ellison syndrome. Hypertension was observed in 84% of the 32 patients. The basal urinary excretion rates were pathologically high in 99% of all measurements, while the excretion rates for 17-OH-steroids were pathologically elevated only in 61% of all measurements. Radioscanning of the adrenal glands was performed in 11 patients with 131I-cholesterol derivatives of NP-59. 4 patients with pituitary Cushing's syndrome had bilaterally increased uptake of activity, while 3 patients with adenoma had uptake of the radiolabeled drug on the side of the lesion. In all 4 patients with a carcinoma, uptake was absent or insufficient. The results show that measurement of the basal urinary excretion rate of free cortisol is a more sensitive means for detection of hypercorticism than measurement of 17-hydroxysteroids. Radioscanning of the adrenal glands provides reliable results in pituitary Cushing's syndrome and adenomas, but, in our cases, not in carcinomas.