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May 1966

Depigmentation in Cushing's Syndrome

Arch Intern Med. 1966;117(5):677-680. doi:10.1001/archinte.1966.03870110069014

THE endocrinological control of pigmentation has been a subject of considerable interest and much investigation. Lerner et al 1 and Lerner,2 in comprehensive reviews, discussed the etiological factors associated with melanin pigmentation. They observed that primary adrenal insufficiency is usually associated with hyperpigmentation, but that adrenal insufficiency secondary to hypopituitism is not. They further suggested that this hyperpigmentation is dependent upon an increase in the circulating levels of the melanocyte stimulating hormone (MSH) and could be controlled by maintenance doses of hydrocortisone. In addition, increased levels of MSH have been detected in the urine of patients suffering from Addison's disease.3

Hyperpigmentation has also been reported following adrenalectomy for Cushing's syndrome where an excessive production of adrenocorticotrophic hormone (ACTH) has persisted following operation.4 In some of these cases an ACTH-producing pituitary tumor has become manifest and the implication has been that the increase of pigment in these patients