[Diagnosis and therapy of Cushing syndrome]

Current diagnostic and therapeutic options in Cushing's syndrome have been retrospectively evaluated on the basis of 40 case histories of the years 1980 to 1994. After biochemical diagnosis, several radiological methods such as 131J-cholesterol-scintigraphy and, in 1 case, selective petrosal sinus blood sampling were employed. Out of 25 patients with central Cushing's syndrome 18 were cured by transsphenoidal pituitary surgery, in 1 case in combination with "Gamma-Knife" therapy. One patient was primarily treated by bilateral adrenalectomy, 5 as second intervention following unsuccessful pituitary surgery. One patient is not fully cured at present. Adrenal cortisol-producing adenomas were successfully treated by unilateral, subtotal or bilateral adrenalectomy in 9, 1 and 2 patients, respectively. Another patient with bilateral adrenal adenomas was treated medically following unilateral adrenalectomy. One patient with a cortisol-producing adrenal carcinoma died shortly after operation. One patient with an ACTH-producing pancreatic islet cell tumor died 1 year after initial remission. Adrenalectomy is the logical therapy in adrenal cortisol-producing adenomas. Improved diagnostic and surgical techniques have reduced bilateral adrenalectomy in patients with central Cushing's syndrome to rare cases in which transsphenoidal surgery (71% success rate) is the therapy of choice.