The letter of Lanska et al concerning our report is misleading in a number of respects. First, the way that the citations are presented implies that objective measurements of the fat distribution in Cushing's syndrome have been previously reported. In fact, none of the publications cited in the letter contains any data concerning patients with Cushing's syndrome. Furthermore, the letter implies that measurements of the "ratio of waist girth to hip girth," as employed in the studies of Hartz et al,1,2 would be abnormal in Cushing's syndrome, but this may not be true. Both hip girth and waist girth might increase in Cushing's syndrome, and their ratio might be little changed. If this is the case, their index would be of no value in diagnosing Cushing's syndrome. Second, the letter states that "in Cushing's syndrome, fat distribution seems to be influenced by the disease." The justification for
Hiramatsu R. Screening for Cushing's Syndrome-Reply. JAMA. 1984;252(3):344–345. doi:10.1001/jama.1984.03350030018011
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