E. PERRY McCULLAGH, M.D.
Department of Endocrinology and Metabolism
CUSHING1 recognized all the important clinical features of the disease that now bears his name, in the 16 patients on whom he based his original monograph in 1932. One observation stood out clearly: spontaneous remissions occurred. One patient received no treatment. The complete remission in another patient cannot be ascribed, as it was originally, to roentgentherapy to the pituitary. The records* indicate that the dose was probably approximately 400 r, which is not enough to produce a therapeutic effect. Remission occurred after roentgentherapy in another patient for whom the dosage is not known, but in view of recent developments is unlikely to have been in an effective range.
We have since learned that the features of Cushing's syndrome can be produced in animals and in man by injecting corticotropin (ACTH) or 17-hydroxycorticosteroids. Although the clinical picture in many patients having Cushing's syndrome is that of pure cortisone-like effects, curious mixtures of these and of other effects are observed, in which some features may be absent or may be greatly exaggerated. It is not infrequent that a mixture of effects of various steroids is seen: androgenic effects, for example, being slight in some patients and severe in others. In patients having carcinoma of the adrenal, especially, the pattern of steroid excretion may show striking alteration as the disease progresses.2 In general, it is recognized today that most of the features of Cushing's syndrome are due to the chronic effects of an excess of hydrocortisone, or in other words hypercortisolemia. It seems . . .