Cushing's Syndrome

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Abstract
Harvey W. Cushing's 1932 description1 of the syndrome that results from long-term exposure to glucocorticoids has not been improved upon, but our understanding of its pathophysiologic features and our ability to diagnose and treat the disorder have increased dramatically.Normal Hypothalamic–Pituitary–Adrenal PhysiologyCorticotropin-releasing hormone (CRH)2 is synthesized in the hypothalamus and carried to the anterior pituitary in portal blood (Figure 1). CRH, whose secretion is regulated by a variety of neurotransmitters,3 is the most potent regulator of corticotropin secretion. Arginine vasopressin and other hypothalamic agents also stimulate corticotropin secretion.4,5 Corticotropin is synthesized as a large precursor, pro-opiomelanocortin (POMC), which . . .