Adrenal Cortical Function Studies in Cushing's Syndrome Due to Nontumorous Adrenocortical Hyperfunction Treated with Pituitary Irradiation

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Abstract
The response to Gel-ACTH Metopirone and dexamethasone suppression has been studied in 8 subjects with nontumorous adrenocortical hyperfunction with Cushing's syndrome. Four patients were clinically active and 4 were in complete clinical remission. All were treated with pitutary irradiation alone or in combination with unilateral adrenalectomy. After pituitary irradiation, serial studies of 4 subjects with active Cushing's syndrome revealed a progressive decreased hyperresponsiveness to stimulation with Gel-ACTH; 3 subjects responded in the same way to Metopirone. In 2 patients this occurred within 2 months after the completion of therapy, and in one subject it antedated any overt clinical improvement. In all 3 subjects in partial clinical remission after pituitary irradiation, the administration of 2 mg of dexamethasone daily for 3 days failed to suppress the urinary excretion of 17-hydroxycorticoids. In 2 of the 4 patients in complete clinical remission, a significant suppression of the urinary excretion of 17-hydroxycorticoids failed to occur following the same regimen. It appears that dexamethasone suppressibility is the last of the indices of adrenocortical function to return to normal (it may never return to normal in some cases) after the successful treatment of Cushing's syndrome due to nontumorous adrenocortical hyperfunction.

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