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Adrenal Secretion After Bilateral Adrenalectomy for Cushing's Syndrome

GEORGE P. KOZAK, M.D.; GEORGE L. PAUK, M.D.; ANTHONY I. VAGNUCCI, M.D.; DAVID P. LAULER, M.D.; and GEORGE W. THORN, M.D., F.A.C.P.
Ann Intern Med. 1966;64(4):778-785. doi:10.7326/0003-4819-64-4-778
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The availability of oral steroid replacement therapy has elevated total bilateral adrenalectomy to the treatment of choice in Cushing's syndrome associated with bilateral adrenal hyperplasia. The development of adrenocorticotrophic hormone (ACTH)-producing pituitary tumors following total adrenalectomy for Cushing's syndrome, despite normal steroid replacement therapy, has constituted a complication in approximately 4 to 5% of such patients (1-3). Recently, another perplexing and frustrating problem has emerged, namely the persistence of continued steroidogenesis despite the complete removal of both adrenals and pituitary irradiation. The difficulties in attempting to identify and remove remnants or accessory foci of adrenal tissue, particularly in previously operated

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