Treatment, and Retreatment, of Cushing's Disease

The proximate cause of the clinical manifestations of Cushing's syndrome — obesity, facial plethora, hirsutism, hypertension, muscle weakness, lethargy, and depression — is excess cortisol secretion. Few of these clinical manifestations are specific to the syndrome, but the presence of several of them should lead clinicians to suspect it (and when many are present, the changes may be dramatic). The next steps are to confirm the presence of cortisol excess and then to determine its cause. The predominant causes of Cushing's syndrome are excess corticotropin secretion, whether from a pituitary tumor (Cushing's disease) or a nonendocrine tumor, and adrenal tumors, . . .