From January 1962 through April 1988, 188 patients with
Cushing's syndrome were hospitalized at the Veterans General Hospital. Iatrogenic
Cushing's syndrome was found in 123 (65.4%) of the patients. The other 43 patients (22.9%) had excess secretion of
adrenocorticotropin (
ACTH) and 22 patients (11.7%) had benign or malignant adrenocortical
tumors. The clinical features and the functional reserve of the adrenal glands in those patients with iatrogenic
Cushing's syndrome were evaluated. A retrospective analysis of the diagnostic rate of the various endocrine evaluations and the radiological examinations was also carried out. Four approaches were used in the management of
Cushing's syndrome: (1) pituitary surgery, (2)
pituitary irradiation, (3) adrenal surgery, and (4)
drug therapy. Both the clinical and hormonal responses to these four management types were evaluated. The endocrinological, radiological, surgical and pathological experiences of 25 patients with
Cushing's disease treated with pituitary surgery are presented. Five patients (20%) had an atypical endocrine pattern (20% false-negative). Twenty-four patients received a pituitary CT scan and 16 patients (66.7%) had positive CT findings. Of these 25 patients, 19 had pathology-proven microadenomas (less than 1cm), one had macroadenoma (greater than 1cm) and 5 had no evidence of adenomatous tissue. Among the 22 patients with adrenal
Cushing's syndrome, 4 (18%) were suffering from
adrenocortical carcinoma and 18 (82%) with benign adrenal
tumors. The incidence of left adrenal
adenoma was approximately twice that of right adrenal
adenoma. The cure rate of
adrenocortical adenoma by surgical treatment with unilateral
adrenalectomy was excellent, but for
adrenocortical carcinoma was poor.