We thank Dr Khardori for his comment and for the opportunity to further discuss the atypical presentations of Cushing syndrome due to ectopic or abnormal receptor expression in the adrenal cortex or to abnormal stimuli. An excellent and updated description of hormone receptor abnormalities in corticotropin-independent Cushing syndrome is provided in the review by Lacroix et al.1 This condition includes food-dependent Cushing syndrome from ectopic expression of the gastric inhibitory peptide receptor in adrenocortical tissue, vasopressin-responsive Cushing syndrome due to exaggerated V1-vasopressin receptor activity, catecholamine-dependent Cushing syndrome caused by aberrant expression of β-adrenergic receptors, and Cushing syndrome due to ectopic expression of other G protein–coupled hormone receptors, including thyrotropin, leuteinizing hormone/human chorionic gonadotropin, follicle-stimulating hormone, serotonin, glucagon, and leptin receptors.
Boscaro M, Barzon L, Sonino N. Considerations in Diagnosis of Cushing Syndrome—Reply. Arch Intern Med. 2001;161(14):1780. doi: