Cushing's Syndrome: Problems in Management*

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Abstract
SINCE the time of Harvey Cushing, great advances have been made in understanding the pathophysiology of Cushing's syndrome (CS). Delineation of the different forms of spontaneous hypercortisolism—pituitary-dependent disease, adrenal tumor, and the ectopic ACTH syndrome—has permitted the development of specific therapies. As Orth and Liddle (1) have defined the ideal treatment, it would lower cortisol secretion to normal, eradicate any tumor threatening the health of the patient, avert permanent endocrine deficiency, and avoid permanent dependence on medication. A variety of therapies—surgical, radiotherapeutic, and medical—has been used. However, the frequent difficulty in establishing the specific cause of hypercortisolism (2) and the inadequacies of current methods of treatment continue to complicate the management of patients with CS. We present seven cases that illustrate our approach to therapeutic dilemmas. Normal Findings on Sellar Tomography This 22-yr-old woman developed amenorrhea, a plethoric moon facies, truncal obesity, purple striae, easy bruisability, hirsutism, and emotional lability. In addition to having this classic cushingoid appearance, she was hypertensive (blood pressure, 150/100 mm Hg) and hyperglycemic (fasting blood glucose, 206 mg/dl) and had a normal serum potassium value.

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