Results of Treatment in 108 Patients with Cushing's Syndrome

Abstract

In 17 years, 108 patients with Cushing's syndrome were treated at Vanderbilt University. Seventeen had adrenal adenoma, 10 adrenal carcinoma, 17 ectopic ACTH syndrome, and 64 Cushing's disease. Surgery for adrenal adenoma was uniformly successful. Three carcinomas were surgically cured, and two patients had remissions; these two and another patient subsequently responded to o.p′DDD. Four cases were not amenable to therapy. No patient with ectopic ACTH syndrome was cured, but some responded metabolically to metyrapone. In Cushing's disease, pituitary irradiation cured 10 of 51 patients and improved 13 without complications. All six unilateral adrenalectomies and two of five subtotal adrenalectomies were unsuccessful, but bilateral adrenalectomy (19 cases) was always curative. After o,p′DDD treatment serum cortisol levels returned to normal, without mineralocorticoid deficiency, in eight patients. Thus, except in patients with ectopic ACTH syndrome or adrenal carcinoma, appropriate treatment for Cushing's syndrome is almost uniformly beneficial.