A Case of Cushing's Syndrome with Adrenal Cortical Hyperplasia, without Pituitary Basophilic Adenoma or Hyperplasia

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Abstract
The case was studied over a period of 8 yrs. Following roentgen-ray treatment of the pituitary gland there was a remission of 1 yr. duration, but further irradiation was without effect. Later treatment with diethylstilbestrol brought temporary remission, but under continued treatment there occurred complete relapse. Gonadotrophic hormone and adrenocor-ticotrophic hormone were excreted in excessive amts. in the early stage, later the values were low. Excretion of andro-genic hormone was excessive, decreased during treatment with diethylstilbestrol and remained low during the fol-lowing relapse. Pregnandiol excretion was present in spite of amenorrhoea and decreased at the same time as did the excretion of androgenic hormone. Osteoporosis was first noted in the 4th yr. of the disease and became severe, leading to collapse of several vertebrae, in the 8th yr. At this time Ca balance was negative; but the N balance was positive. Some of the observations lead to the belief that at first the pituitary gland is overactive. By the time the pituitary gland exhausts itself, the adrenal cortex is sufficiently stimulated to continue overactivity independently. This tends to support the interpretation of Crooke changes in the basophilic cells of the pituitary gland given by Severinghaus and Thompson. Crooke changes were also found in this case.