Cushing's Syndrome With Dual Pituitary-Adrenal Control

Young Choi, MD; Emile E. Werk Jr., MD; Leon J. Sholiton, MD
Arch Intern Med. 1970;125(6):1045-1049. doi:10.1001/archinte.1970.00310060123016.
Text Size: A A A
Published online

Controversy exists as to the pathophysiology in Cushing's syndrome with nodular adrenocortical hyperplasia. Of the eight patients reported by Meador et al in 1967, all showed resistance to dexamethasone suppression.1 However responses to corticotropin and metyrapone were variable, and plasma adrenocorticotropic hormone (ACTH) levels by bioassay, ranged from low to normal. Consequently, opinion has differed as to whether this condition represents a primary hypothalamic pituitary defect, primary adrenal autonomy, or a combination of both.

The patient with nodular adrenocortical hyperplasia reported here illustrates the complex combination of pituitary-adrenal control that may be present and the danger of isolated measurements of plasma ACTH concentration and dexamethasone suppression.

Patient Summary  A 44-year-old woman entered Cincinnati General Hospital in June 1966, referred by her private physician who diagnosed possible Cushing's syndrome. She was in good health until six years prior to this admission, when she began to experience menorrhagia, hot flushes, and


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.