Periodic Remission in Cushing's Disease with Paradoxical Dexamethasone Response: An Expression of Periodic Hormonogenesis

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Abstract
A patient with Cushing's disease due to a chromophobe adenoma was studied for 243 days before pituitary surgery and evidence for periodicity in cortisol steroid production wasfound with cycles occurring every 85.8 days (peak-to-peak length), associated with laboratory remissions and paradoxical response to dexamethasone. The autonomy of ACTH secretion was suggested by the nonresponsiveness to repeated lysine-vasopressin stimulation tests and lack of increase in urinary 170HCS following metyrapone. A distinct response of the hyperplastic glands (as demonstrated by percutaneous adrenal venography) was obtained on several B1–24 corticotropin stimulation. The patient's hypercortisolism disappeared following removal of the chromophobe adenoma throughtransphenoidal hypophysectomy.