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Cushing's disease: dilemmas of diagnosis and management.

Abstract
Determining the cause of Cushing's disease and correcting the abnormality presents a continuing challenge to the clinician despite remarkable advances in diagnostic and therapeutic techniques. We present seven cases to illustrate 1) the classic disorder cured by pituitary adenomectomy; 2) persistence of the disease after adenomectomy; 3) Cushing's disease manifesting in the puerperium and remitting with dopamine agonist therapy; 4) a patient whose disease relapsed at least five times during 20 years of treatment by adrenalectomy, pituitary radiation, mitotane, and pituitary adenomectomy; 5) the Nelson syndrome; 6) the ectopic adrenocorticotropic hormone (ACTH) syndrome in a patient with dexamethasone suppressible urinary cortisol who had a pituitary adenoma which stained positively for ACTH but who was not cured by total hypophysectomy; and 7) a patient whose ACTH-secreting tumor proved fatal despite repeated surgical, radiologic and pharmacologic measures.
AuthorsM Saeed-uz-Zafar, R C Mellinger, M Wisgerhof
JournalHenry Ford Hospital medical journal (Henry Ford Hosp Med J) Vol. 39 Issue 1 Pg. 10-7 ( 1991) ISSN: 0018-0416 [Print] United States
PMID1649807 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Adrenocorticotropic Hormone
Topics
  • Adrenocorticotropic Hormone (blood)
  • Adult
  • Aged
  • Cushing Syndrome (blood, complications, diagnosis, therapy)
  • Female
  • Humans
  • Hypophysectomy
  • Male
  • Nelson Syndrome (etiology)
  • Puerperal Disorders (diagnosis)
  • Recurrence

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