Pituitary-Adrenal Functional Abnormalities in Corticogenic Adrenal Atrophy

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Abstract
Hypothalamo-pituitary and adrenocortical function were studied in 3 patients with Cushing''s syndrome before and after removal of a unilateral adrenocortical adenoma. Post-operatively, the response in each patient to sustained ACTH stimulation and to intermittent ACTH stimulation for periods of 6 weeks to 1 year were studied. Both hypothalamo-pituitary and adrenocortical dysfunction were demonstrated in all, as evidenced by low basal urinary steroid excretion and abnormal responses to ACTH or to Su-4885 administration during the first 4-9 months postoperatively. These data indicate that adrenocortical atrophy of the corticogenic type is a complex lesion involving abnormalities of both the hypothalamo-pituitary axis and the adrenal cortex. The recurrence of Cushing''s syndrome in 1 patient due to autonomous multinodular adrenal cortical hyperplasia in the remaining adrenal gland 4 years after unilateral adrenalectomy, we believe, represents the 2nd example of this syndrome.