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ARTICLE |

Cushing's Syndrome—Still a Conundrum FREE

Samuel Vaisrub, MD
JAMA. 1978;240(9):865-865. doi:10.1001/jama.1978.03290090059024
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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

REFERENCES

Feldman JM:  Cushing's disease: A hypothalamic flush? N Engl J Med 293:930-931, 1975;.
Tyrrell JB, Brooks RM, Fitzgerald PA, et al:  Cushing's disease selective transsphenoidal resection of pituitary microadenomas . N Engl J Med 298:753-757, 1978;.
Daughaday WH:  Cushing's disease and basophilic microadenomas . N Engl J Med 298:793-794, 1978;.
Krieger DT, Amorosa L, Linick F:  Cyproheptadine-induced remission of Cushing's disease . N Engl J Med 293:893-896, 1975;.
Krieger DT:  Cyproheptadine for pituitary disorders . N Engl J Med 295:394-395, 1976;.
Krieger DT:  Sleep EEG stages and plasma growth hormone concentration in states of endogenous and exogenous hypercortisolemia and ACTH elevation . J Clin Endocrinol Metab 39:986-1000, 1974;.
Chakrabarty AS, Pillai RV, Anand BK, et al:  Effect of cyproheptadine on the electrical activity of the hypothalamic feeding centers . Brain Res 6:561-569, 1967;.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

Feldman JM:  Cushing's disease: A hypothalamic flush? N Engl J Med 293:930-931, 1975;.
Tyrrell JB, Brooks RM, Fitzgerald PA, et al:  Cushing's disease selective transsphenoidal resection of pituitary microadenomas . N Engl J Med 298:753-757, 1978;.
Daughaday WH:  Cushing's disease and basophilic microadenomas . N Engl J Med 298:793-794, 1978;.
Krieger DT, Amorosa L, Linick F:  Cyproheptadine-induced remission of Cushing's disease . N Engl J Med 293:893-896, 1975;.
Krieger DT:  Cyproheptadine for pituitary disorders . N Engl J Med 295:394-395, 1976;.
Krieger DT:  Sleep EEG stages and plasma growth hormone concentration in states of endogenous and exogenous hypercortisolemia and ACTH elevation . J Clin Endocrinol Metab 39:986-1000, 1974;.
Chakrabarty AS, Pillai RV, Anand BK, et al:  Effect of cyproheptadine on the electrical activity of the hypothalamic feeding centers . Brain Res 6:561-569, 1967;.
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