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Cushing's Syndrome and the Changing Times

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Endocrine-Hypertension Unit, Brigham and Women's Hospital; Boston, Massachusetts

Ann Intern Med. 1982;97(1):131-133. doi:10.7326/0003-4819-97-1-131
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Although Cushing's syndrome represents a group of diseases, the hypercortisolism can be viewed more simply as a consequence of a primary adrenal neoplasm or of continuous adrenocorticotropic hormone (ACTH) stimulation leading to bilateral adrenal hyperplasia. The ACTH hypersecretion may be marked, as in neoplasms that secrete ACTH "ectopically" (primarily lung neoplasms). On the other hand, pituitary ACTH secretion may be modestly increased or "inappropriately" normal in the setting of elevated Cortisol levels, suggesting an abnormality in the negative feedback relation between Cortisol and ACTH in these patients (so-called idiopathic hyperplasia or Cushing's disease). That there may be abnormal regulation of


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