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September 1, 1978

Cushing's Syndrome—Still a Conundrum

JAMA. 1978;240(9):865. doi:10.1001/jama.1978.03290090059024

Hypersecretory endocrinopathies are generally treated by surgical removal or radiation of the incriminated gland even when direct pharmacologic antagonists to its oversecreted hormone are available. Such drugs are often unsuited for prolonged use because of toxic effects or loss of effectiveness. Apart from offering a prompt cure, surgical or radiological ablation of a gland eliminates the risk of malignant change or spatial expansion. On the other hand, ablation frequently generates undesirable complications, such as uncontrolled overactivity of a modulating organ and a need for major, lifelong replacement therapy. Perplexities mount when the primary cause of the endocrinopathy is called into question. Is the hyperactive organ the true culprit, or is it merely a puppet manipulated by an organ in a higher order of the endocrine hierarchy?

These sources of hesitancy and confusion are epitomized in the therapeutic and conceptual approaches to Cushing's syndrome. Adrenalectomy, which is still the most widely