Skip to main content
SpringerLink
Log in

Corticotroph Adenomas

Cushing’s Disease and Nelson’s Syndrome

  • Chapter
Diagnosis and Management of Pituitary Tumors

  • 225 Accesses

Abstract

In 1932, Harvey Cushing published a report of 12 cases in which he described the metabolic derangements associated with pituitary basophilic adenomas, characterizing the syndrome that was later to bear his name (1). The term Cushing’s syndrome refers to the clinical manifestations of glucocorticoid excess regardless of specific etiology, whereas Cushing’s disease refers to those cases of Cushing’s syndrome secondary to pituitary adrenocorticotropic hormone (ACTH) hypersecretion. In the adult population, Cushing’s disease accounts for approx 70% of patients with endogenous Cushing’s syndrome, whereas the remaining 30% are attributable to the ectopic ACTH syndrome and primary adrenal tumors (2).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Cushing H. The basophil adenomas of the pituitary body and their clinical manifestations (pituitary basophilism). Bull Johns Hopkins Hosp 1932;50:137–195.

    Google Scholar 

  2. Huff TA. Clinical syndromes related to disorders of adrenocorti-cotrophic hormone. In: Allen MB, Mahesh VB, eds. The Pituitary: A Current Review. Academic, New York, 1977, p. 154.

    Google Scholar 

  3. Mindermann T, Wilson CB. Age-related and gender-related occurrence of pituitary adenomas. Clin Endocrinol (Oxford) 1994;41:359–364.

    CAS  Google Scholar 

  4. Mampalam TJ, Tyrrell JB, Wilson CB. Transsphenoidal microsurgery for Cushing disease: A report of 216 cases. Ann Intern Med 1988;109:487–493.

    PubMed  CAS  Google Scholar 

  5. Plotz CM, Knowlton AI, Ragan C. The natural history of Cushing’s syndrome. Am J Med 1952;13:597–614.

    PubMed  CAS  Google Scholar 

  6. Krieger DT. Physiopathology of Cushing’s disease. Endocr Rev 1983;4:22–43.

    PubMed  CAS  Google Scholar 

  7. Biller BMK. Pathogenesis of pituitary Cushing’s syndrome: Pituitary versus hypothalamic. Endocrinol Metab Clin North Am 1994;23(3):547–554.

    PubMed  CAS  Google Scholar 

  8. Saeger W, Ludecke DK. Pituitary hyperplasia. Virchows Arch 1983;399:277–287.

    CAS  Google Scholar 

  9. Gertz BJ, Contreras LN, McComb DJ, Kovacs K, Tyrrell JB, Dallman MF. Chronic administration of corticotropin-releasing factor increases pituitary corticotroph number. Endocrinology 1987;120:381–388.

    PubMed  CAS  Google Scholar 

  10. Carey RM, Varma SK, Drake CR, Thorner MO, Kovacs K, Rivier J, et al. Ectopic secretion of corticotropin-releasing factor as a cause of Cushing’s syndrome. N Engl J Med 1984;311:13–20.

    PubMed  CAS  Google Scholar 

  11. Belsky JL, Cuello B, Swanson W, Simmons DM, Jarrett RM, Braza F. Cushing’s syndrome due to ectopic production of corticotropin-releasing factor. J Clin Endocrinol Metab 1985;60:496–500.

    PubMed  CAS  Google Scholar 

  12. Krieger DT. Medical management of Cushing’s disease. In: Black PM, Zervas NT, Ridgway EC, Martin JB, eds. Secretory Tumors of the Pituitary Gland. Raven, New York, 1984, pp. 273–285.

    Google Scholar 

  13. Tyrrell JB, Wilson CB. Cushing’s disease: Therapy of pituitary adenomas. Endocrinol Metab Clin North Am 1994;23(4):925–938.

    PubMed  CAS  Google Scholar 

  14. Fitzgerald PA, Aron DC, Findling JW, Brooks RM, Wilson CB, Forsham PH, et al. Cushing’s disease: Transient secondary adrenal insufficiency after selective removal of pituitary microadenomas; Evidence for a pituitary origin. J Clin Endocrinol Metab 1982; 54:413–422.

    PubMed  CAS  Google Scholar 

  15. Nakane T, Kuwayama A, Watanabe M, Takahashi T, Kato T, Ichihara K, et al. Long term results of transsphenoidal adenomectomy in patients with Cushing’s disease. Neurosurgery 1987;21:218–222.

    PubMed  CAS  Google Scholar 

  16. Gicquel C, Le Bouc Y, Luton J, Girard F, Bertagna X. Monoclonality of corticotroph macroadenomas in Cushing’s disease. J Clin Endocrinol Metab 1992;75:472–475.

    PubMed  CAS  Google Scholar 

  17. Herman V, Fagin J, Gonsky R, Kovacs K, Melmed S. Clonal origin of pituitary adenomas. J Clin Endocrinol Metab 1990;71:1427–1433.

    PubMed  CAS  Google Scholar 

  18. Biller BMK, Alexander JM, Zervas NT, Hedley-Whyte ET, Arnold A, Klibanski A. Clonal origins of adrenocorticotropin-secreting pituitary tissue in Cushing’s disease. J Clin Endocrinol Metab 1992;75:1303–1309.

    PubMed  CAS  Google Scholar 

  19. Nugent CA, Warner HR, Dunn JT, Tyler FH. Probability theory in the diagnosis of Cushing’s syndrome. J Clin Endocrinol 1964;24: 621–627.

    CAS  Google Scholar 

  20. Ross EJ, Linch DC. Cushing’s syndrome—killing disease: Discriminatory value of signs and symptoms aiding early diagnosis. Lancet 1982;2:646–649.

    PubMed  CAS  Google Scholar 

  21. Hiramatsu R, Yoshida K, Sato T. A body measurement to evaluate the pattern of fat distribution in central obesity. JAMA 1983;250: 3174–3178.

    PubMed  CAS  Google Scholar 

  22. Yanovski JA, Cutler GB. Glucocorticoid action and the clinical features of Cushing’s syndrome. Endocrinol Metab Clin North Am 1994;23(3):487–509.

    PubMed  CAS  Google Scholar 

  23. Findling JW, Aron DC, Tyrrell JB. Cushing’s Disease. In: Imura H, ed. The Pituitary Gland. Raven, New York, 1985, pp. 441–446.

    Google Scholar 

  24. Bouzas EA, Mastorakos G, Friedman TC, Scott MH, Chrousos GP, Kaiser-Kupfer MI. Posterior subcapsular cataract in endogenous Cushing syndrome: An uncommon manifestation. Invest Ophthalmol Vis Sci 1993;34:3497–3500.

    PubMed  CAS  Google Scholar 

  25. Nugent CA, Nichols T, Tyler FH. Diagnosis of Cushing’s syndrome. Arch Intern Med 1965;116:172–176.

    PubMed  CAS  Google Scholar 

  26. Pavlatos FC, Smilo RP, Forsham PH. A rapid screening test for Cushing’s syndrome. 1965 JAMA 1965;193:96–99.

    Google Scholar 

  27. Fok ACK, Tan KT, Jacob E, Sum CF. Overnight (1 mg) dexa-methasone suppression testing reliably distinguishes non-cushingoid obesity from Cushing’s syndrome. Steroids 1991;56:549–551.

    PubMed  CAS  Google Scholar 

  28. Wood PJ, Barth JH, Freedman DB, Perry L, Sheridan B. Evidence for the low dose dexamethasone suppression test to screen for Cushing’s syndrome-recommendations for a protocol for biochemistry laboratories. Ann Clin Biochem 1997;34: 222–229.

    PubMed  CAS  Google Scholar 

  29. Cronin C, Igoe D, Duffy MJ, Cunningham SK, McKenna TJ. Clin Endocrinol (Oxford) 1990;33:27–33.

    CAS  Google Scholar 

  30. Crapo L. Cushing’s syndrome: A review of diagnostic tests. Metabolism 1979;28:955–977.

    PubMed  CAS  Google Scholar 

  31. Findling JW, Doppman JL. Biochemical and radiologic diagnosis of Cushing’s syndrome. Endocrinol Metab Clin North Am 1994;23:511–537.

    PubMed  CAS  Google Scholar 

  32. Mengden T, Hubmann P, Muller J, Greminger P, Vetter W. Urinary free Cortisol versus 17-hydroxycorticosteroids: A comparative study of their diagnostic value in Cushing’s syndrome. Clin Invest 1992;70:545–548.

    CAS  Google Scholar 

  33. Schoneshofer M, Fenner A, Altinok G, Dulce HJ. Specific and practicable assessment of urinary free Cortisol by combination of automatic high-pressure liquid chromatography and radioimmunoassay. Clin Chim Acta 1980;106:63–73.

    PubMed  CAS  Google Scholar 

  34. Liddle GW. Tests of pituitary-adrenal suppressibility in the diagnosis of Cushing’s syndrome. J Clin Endocrinol Metab 1960;20: 1539–1560.

    PubMed  CAS  Google Scholar 

  35. Newell-Price J, Trainer P, Besser M, Grossman A. The diagnosis and differential diagnosis of Cushing’s syndrome and pseudo-Cushing’s states. Endocr Rev 1998; 19:647–672.

    PubMed  CAS  Google Scholar 

  36. Newell-Price J, Trainer P, Perry L, Wass J, Grossman A, Besser M. A single sleeping midnight Cortisol has 100% sensitivity for the diagnosis of Cushing’s syndrome. Clin Endocrinol (Oxford) 1995;43:545–550.

    CAS  Google Scholar 

  37. Raff H, Raff JL, Findling JW. Late-night salivary Cortisol as a screening test for Cushing’s syndrome. J Clin Endocrinol Metab 1998;83:2681–2686.

    PubMed  CAS  Google Scholar 

  38. Yanovski JA, Cutler GB, Chrousos GP, Nieman LK. Corticotropin-releasing hormone stimulation following low-dose dexamethasone administration. JAMA 1993;269:2232–2238.

    PubMed  CAS  Google Scholar 

  39. Papanicolaou DA, Yanovski JA, Cutler GB, Chrousos GP, Nieman LK. A single midnight serum Cortisol measurement distinguishes Cushing’s syndrome from pseudo-Cushing states. J Clin Endocrinol Metab 1998;83:1163–1167.

    PubMed  CAS  Google Scholar 

  40. Raff H, Findling JW. A new immunoradiometric assay for corticotropin evaluated in normal subjects and patients with Cushing’s syndrome. Clin Chem 1989;35:596–600.

    PubMed  CAS  Google Scholar 

  41. Findling JW. Clinical application of a new immunoradiometric assay for ACTH. Endocrinologist 1992;2:360–365.

    Google Scholar 

  42. Tyrrell JB, Findling JW, Aron DC, Fitzgerald PA, Forsham PH. An overnight high-dose dexamethasone suppression test for rapid differential diagnosis of Cushing’s syndrome. Ann Intern Med 1986;104:180–186.

    PubMed  CAS  Google Scholar 

  43. Dichek HL, Nieman LK, Oldfield EH, Pass HI, Malley JD, Cutler GB. A comparison of the standard high dose dexamethasone suppression test and the overnight 8 mg dexamethasone suppression test for the differential diagnosis of adrenocorticotropin-depen-dent Cushing’s syndrome. J Clin Endocrinol Metab 1994;78: 418–422.

    PubMed  CAS  Google Scholar 

  44. Bruno OD, Rossi MA, Contreras LN, Gomez RM, Galparsoro G, Cazado E, et al. Nocturnal high-dose dexamethasone suppression test in the aetiological diagnosis of Cushing’s syndrome. Acta Endocrinol (Copenh) 1985;109:158–162.

    CAS  Google Scholar 

  45. Limper AH, Carpenter PC, Scheithauer B, Staats B A. The Cushing syndrome induced by bronchial carcinoid tumors. Ann Intern Med 1992;117:209–214.

    PubMed  CAS  Google Scholar 

  46. Grossman AB, Howlett TA, Perry L, Coy DH, Savage MO, Lavender P, et al. CRF in the differential diagnosis of Cushing’s syndrome: A comparison with the dexamethasone suppression test. Clin Endocrinol (Oxford) 1988;29:167–178.

    CAS  Google Scholar 

  47. Findling JW, Tyrrell JB. Occult ectopic secretion of corticotropin. Arch Intern Med 1986;146:929–933.

    PubMed  CAS  Google Scholar 

  48. Aron DC, Raff H, Findling JW. Effectiveness versus efficacy: The limited value in clinical practice of high dose dexamethasone suppression testing in the differential diagnosis of adrenocorticotro-pin-dependent Cushing’s syndrome. J Clin Endocrinol Metab 1997;82:1780–1785.

    PubMed  CAS  Google Scholar 

  49. Loriaux DL, Nieman L. Corticotropin-releasing hormone testing in pituitary disease. Endocrinol Metab Clin North Am 1991,20(2): 363–369.

    PubMed  CAS  Google Scholar 

  50. Nieman LK, Oldfield EH, Wesley R, Chrousos GP, Loriaux DL, Cutler GB. A simplified morning ovine corticotropin-releasing hormone stimulation test for the differential diagnosis of adreno-corticotropin-dependent Cushing’s syndrome. J Clin Endocrinol Metab 1993;77:1308–1312.

    PubMed  CAS  Google Scholar 

  51. Tabarin A, Greselle JF, San-Galli F, Leprat F, Caille JM, Latapie JL, et al. Usefulness of the corticotropin-releasing hormone test during bilateral inferior petrosal sinus sampling for the diagnosis of Cushing’s disease. J Clin Endocrinol Metab 1991;73:53–59.

    PubMed  CAS  Google Scholar 

  52. Newell-Price J, Perry L, Medbak S, Monson J, Savage M, Besser M, et al. A combined test using desmopressin and corticotropin-releasing hormone in the differential diagnosis of Cushing’s syndrome. J Clin Endocrinol Metab 1997;82:176–181.

    PubMed  CAS  Google Scholar 

  53. Dickstein G, DeBold CR, Gaitan D, DeCherney GS, Jackson RV, Sheldon WR, et al. Plasma corticotropin and Cortisol responses to ovine corticotropin-releasing hormone (CRH), arginine vasopressin (AVP), CRH plus AVP, and CRH plus metyrapone in patients with Cushing’s disease. J Clin Endocrinol Metab 1996; 81:2934–2941.

    PubMed  CAS  Google Scholar 

  54. Avgerinos PC, Yanovski J A, Oldfield EH, Nieman LK, Cutler GB. The metyrapone and dexamethasone suppression tests for the differential diagnosis of the adrenocorticotropin-dependent Cushing’s syndrome: A comparison. Ann Intern Med 1994; 121: 318–327.

    PubMed  CAS  Google Scholar 

  55. Nieman LK, Chrousos GP, Oldfield EH, Avgerinos PC, Cutler GB, Loriaux DL. The ovine corticotropin-releasing hormone stimulation test and the dexamethasone suppression test in the differential diagnosis of Cushing’s syndrome. Ann Intern Med 1986;105:862–867.

    PubMed  CAS  Google Scholar 

  56. Findling JW. Eutopic or ectopic adrenocorticotropic hormone-dependent Cushing’s syndrome? A diagnostic dilemma. Mayo Clin Proc 1990;65:1377–1380.

    PubMed  CAS  Google Scholar 

  57. Buchfelder M, Nistor R, Fahlbusch R, Huk WJ. The accuracy of CT and MR evaluation of the sella turcica for detection of adrenocorticotropic hormone-secreting adenomas in Cushing disease. Am J Neuroradiol 1993;14:1183–1190.

    PubMed  CAS  Google Scholar 

  58. Marcovitz S, Wee R, Chan J, Hardy J. The diagnostic accuracy of preoperative CT scanning in the evaluation of pituitary ACTH-secreting adenomas. Am J Neuroradiol 1987;8:641–644.

    Google Scholar 

  59. Saris SC, Patronas NJ, Doppman JL, Loriaux DL, Cutler GB, Nieman LK, et al. Cushing syndrome: Pituitary CT scanning. Radiology 1987;162:775–777.

    PubMed  CAS  Google Scholar 

  60. Colombo N, Loli P, Vignati F, Scialfa G. MR of corticotropin-secreting pituitary microadenomas. Am J Neuroradiol 1994; 15: 1591–1595.

    PubMed  CAS  Google Scholar 

  61. Peck WW, Dillon WP, Norman D, Newton TH, Wilson CB. High-resolution MR imaging of microadenomas at 1.5 T: Experience with Cushing disease. Am J Neuroradiol 1988;9:1085–1091.

    Google Scholar 

  62. de Herder WW, Uitterlinden P, Pieterman H, Tanghe HLJ, Kwekkeboom DJ, Pois HAP, et al. Pituitary tumor localization in patients with Cushing’s disease by magnetic resonance imaging. Is there a place for petrosal sinus sampling? Clin Endocrinol (Oxford) 1994;40:87–92.

    Google Scholar 

  63. Scanarini M. Transsphenoidal surgery in Cushing’s disease and Nelson’s syndrome. J Endocrinol Invest 1992;15:230–231.

    Google Scholar 

  64. Burrow GN, Wortzman G, Rewcastle NB, Holgate RC, Kovacs K. Microadenomas of the pituitary and abnormal sellar tomograms in an unselected autopsy series. N Engl J Med 1981;304:156–158.

    PubMed  CAS  Google Scholar 

  65. Parent AD, Bebin J, Smith RR. Incidental pituitary adenomas. J Neurosurg 1981;54:228–231.

    PubMed  CAS  Google Scholar 

  66. Hall WA, Luciano MG, Doppman JL, Patronas NJ, Oldfield EH. Pituitary magnetic resonance imaging in normal human volunteers: Occult adenomas in the general population. Ann Intern Med 1994;120:817–820.

    PubMed  CAS  Google Scholar 

  67. Ludecke DK. Transnasal microsurgery of Cushing’s disease 1990. Pathol Res Pract 1991;187:608–612.

    PubMed  CAS  Google Scholar 

  68. Oldfield EH, Girton ME, Doppman JL. Absence of intercavernous venous mixing: Evidence supporting lateralization of pituitary microadenomas by venous sampling. J Clin Endocrinol Metab 1985;61:644–647.

    PubMed  CAS  Google Scholar 

  69. Miller DL, Doppman JL. Petrosal sinus sampling: Technique and rationale. Radiology 1991;178:37–47.

    PubMed  CAS  Google Scholar 

  70. Doppman JL, Oldfield E, Krudy AG, Chrousos GP, Schulte HM, Schaaf M, et al. Petrosal sinus sampling for Cushing syndrome: Anatomical and technical considerations. Radiology 1984; 150: 99–103.

    PubMed  CAS  Google Scholar 

  71. Miller DL, Doppman JL, Peterman SB, Nieman LK, Oldfield EH, Chang R. Neurologic complications of petrosal sinus sampling. Radiology 1992;185:143–147.

    PubMed  CAS  Google Scholar 

  72. Corrigan DF, Schaaf M, Whaley RA, Czerwinski CL, Earll JM. Selective venous sampling to differentiate ectopic ACTH secretion from pituitary Cushing’s syndrome. N Engl J Med 1977; 296:861–862.

    PubMed  CAS  Google Scholar 

  73. Findling JW, Aron DC, Tyrrell JB, Shinsako JH, Fitzgerald PA, Norman D, et al. Selective venous sampling for ACTH in Cushing’s syndrome: Differentiation between Cushing’s disease and the ectopic ACTH syndrome. Ann Intern Med 1981;94:647–652.

    PubMed  CAS  Google Scholar 

  74. Oldfield EH, Chrousos GP, Schulte HM, Schaaf M, McKeever PE, Krudy AG, et al. Preoperative lateralization of ACTH-secret-ing pituitary microadenomas by bilateral and simultaneous inferior petrosal venous sinus sampling. N Engl J Med 1985;312: 100–103.

    PubMed  CAS  Google Scholar 

  75. Findling JW, Aron DC, Tyrrell JB. Glucocorticoid and adrenal androgens. In: Greenspan FS, Strewler GJ, eds. Basic and Clinical Endocrinology. Stamford, CT, Appleton & Lange, 1997, pp. 317–358.

    Google Scholar 

  76. Oldfield EH, Doppman JL, Nieman LK, Chrousos GP, Miller DL, Katz DA, et al. Petrosal sinus sampling with and without corticotropin-releasing hormone for the differential diagnosis of Cushing’s syndrome. N Engl J Med 1991;325:897–905.

    PubMed  CAS  Google Scholar 

  77. Kaltsas GA, Giannulis MG, Newell-Price JDC, Dacie JE, Thakkar C, Afshar F, Monson JP, Grossman AB, Besser GM, Trainer PJ. A critical analysis of the value of simultaneous inferior petrosal sinus sampling in Cushing’s disease and the occult ectopic adrenocorticotropin syndrome. J Clin Endocrinol Metab 1999;84:487–492.

    PubMed  CAS  Google Scholar 

  78. Findling JW, Kehoe ME, Shaker JL, Raff H. Routine inferior petrosal sinus sampling in the differential diagnosis of adrenocorticotropin (ACTH)-dependent Cushing’s syndrome: Early recognition of the occult ectopic ACTH syndrome. J Clin Endocrinol Metab 1991;73:408–413.

    PubMed  CAS  Google Scholar 

  79. Findling JW, Raff H. Newer diagnostic techniques and problems in Cushing’s disease. Endocrinol Metab Clin North Am 1999; 28(1):191–210.

    PubMed  CAS  Google Scholar 

  80. Doppman JL, Chang R, Oldfield EH, Chrousos G, Stratakis CA, Nieman LK. The hypoplastic inferior petrosal sinus: A potential source of false-negative results in petrosal sampling for Cushing’s disease. J Clin Endocrinol Metab 1999;84:533–540.

    PubMed  CAS  Google Scholar 

  81. Mamelak AN, Dowd CF, Tyrrell JB, McDonald JF, Wilson CB. Venous angiography is needed to interpret inferior petrosal sinus and cavernous sinus sampling data for lateralizing adrenocorti-cotropin-secreting adenomas. J Clin Endocrinol Metab 1996;81:475–481.

    PubMed  CAS  Google Scholar 

  82. Miller DL, Doppman JL, Nieman LK, Cutler GB, Chrousos G, Loriaux DL, et al. Petrosal sinus sampling: Discordant lateralization of ACTH-secreting pituitary microadenomas before and after stimulation with corticotropin-releasing hormone. Radiology 1990;176:429–431.

    PubMed  CAS  Google Scholar 

  83. Wilson CB, Mindermann T, Tyrrell JB. Extrasellar, intracavernous sinus adrenocorticotropin-releasing adenoma causing Cushing’s disease. J Clin Endocrinol Metab 1995;80:1774–1777.

    PubMed  CAS  Google Scholar 

  84. Teramoto A, Nemoto S, Takakura K, Sasaki Y, Machida T. Selective venous sampling directly from cavernous sinus in Cushing’s syndrome. J Clin Endocrinol Metab 1993;76:637–641.

    PubMed  CAS  Google Scholar 

  85. Graham KE, Samuels MH, Nesbit GM, Cook DM, O’Neill OR, Barnwell SL, Loriaux DL. Cavernous sinus sampling is highly accurate in distinguishing Cushing’s disease from the ectopic adrenocorticotropin syndrome and in predicting intrapituitary tumor location. J Clin Endocrinol Metab 1999; 84:1602–1610.

    PubMed  CAS  Google Scholar 

  86. Doppman JL, Nieman LK, Chang R, Yanovski J, Cutler GB, Chrousos GP, et al. Selective venous sampling from the cavernous sinuses is not a more reliable technique than sampling from the inferior petrosal sinuses in Cushing’ s syndrome. J Clin Endocrinol Metab 1995;80:2485–2489.

    PubMed  CAS  Google Scholar 

  87. Samuels MH, Cook DM, O’Neill O, Nesbitt G, Barnwell S, Loriaux DL. Cavernous sinus sampling (CSS) is superior to inferior petrosal sinus sampling (IPSS) in the evaluation of Cushing’s syndrome. Presented at the 10th International Congress of Endocrinology, Abstract OR49–3. San Francisco, June 1996.

    Google Scholar 

  88. Hardy J. Transphenoidal microsurgery of the normal and pathological pituitary. Clin Neurosurg 1969;16:185–217.

    PubMed  CAS  Google Scholar 

  89. Burch W. A survey of results with transsphenoidal surgery in Cushing’s disease. N Engl J Med 1983;308:103–104.

    PubMed  CAS  Google Scholar 

  90. Wilson CB. A decade of pituitary microsurgery. J Neurosurg 1984;61:814–833.

    PubMed  CAS  Google Scholar 

  91. Wilson CB, Dempsey LC. Transsphenoidal microsurgical removal of 250 pituitary adenomas. J Neurosurg 1978;48:13–22.

    PubMed  CAS  Google Scholar 

  92. Wilson CB. The long-term results following pituitary surgery for Cushing’s disease and Nelson’s syndrome. In: Black PM, Zervas NT, Ridgway EC, Martin JB, eds. Secretory Tumors of the Pituitary Gland. Raven, New York, 1984, pp. 287–294.

    Google Scholar 

  93. Landolt AM, Schubiger O, Maurer, Girard J. The value of inferior petrosal sinus sampling in diagnosis and treatment of Cushing’s disease. Clin Endocrinol (Oxford) 1994;40:485–492.

    CAS  Google Scholar 

  94. Wilson CB, Tyrrell JB, Fitzgerald PA, Pitts LH. Cushing’s disease and Nelson’s syndrome. Clin Neurosurg 1980;27:19–30.

    PubMed  CAS  Google Scholar 

  95. McCance DR, Besser M, Atkinson AB. Assessment of cure after transsphenoidal surgery for Cushing’s disease. Clin Endocrinol (Oxford) 1996;44:1–6.

    CAS  Google Scholar 

  96. Trainer PJ, Lawrie HS, Verhelst J, Howlett TA, Lowe DG, Grossman AB, Savage MO, et al. Transsphenoidal resection in Cushing’s disease: Undetectable serum Cortisol as the definition of successful treatment. Clin Endocrinol (Oxford) 1993;38:73–78.

    CAS  Google Scholar 

  97. Bochicchio D, Losa M, Buchfelder M, et al. Factors influencing the immediate and late outcome of Cushing’s disease treated by transsphenoidal surgery: A retrospective study by the European Cushing’s Disease Survey Group. J Clin Endocrinol Metab 1995;80:3114–3120.

    PubMed  CAS  Google Scholar 

  98. McCance DR, Gordon DS, Fannin TF, Hadden DR, Kennedy L, Sheridan B, et al. Assessment of endocrine function after transsphenoidal surgery for Cushing’s disease. Clin Endocrinol (Oxford) 1993;38:79–86.

    CAS  Google Scholar 

  99. Friedman TC, Chrousos GP. Transsphenoidal resection in Cushing’s disease: Definition of success. Clin Endocrinol (Oxford) 1993; 39:701.

    CAS  Google Scholar 

  100. Toms GC, McCarthy MI, Niven MJ, Orteu CH, King TT, Monson JP. Predicting relapse after transsphenoidal surgery for Cushing’s disease. J Clin Endocrinol Metab 1993;76:291–294.

    PubMed  CAS  Google Scholar 

  101. Arnott RD, Pestell RG, McKelvie PA, Henderson JK, McNeill PM, Alford FP. A critical evaluation of transsphenoidal pituitary surgery in the treatment of Cushing’s disease: Prediction of outcome. Acta Endocrinol (Copenh) 1990;123:423–430.

    CAS  Google Scholar 

  102. Jeffcoate WJ, Dauncey S, Selby C. Restoration of dexamethasone suppression by incomplete adenomectomy in Cushing’s disease. Clin Endocrinol (Oxford) 1985;23:193–199.

    CAS  Google Scholar 

  103. Avgerinos PC, Chrousos GP, Nieman LK, Oldfield EH, Loriaux DL, Cutler GB. The corticotropin-releasing hormone test in the postoperative evaluation of patients with Cushing’s syndrome. J Clin Endocrinol Metab 1987;65:906–913.

    PubMed  CAS  Google Scholar 

  104. Aron DC, Findling JW, Tyrrell JB. Cushing’s disease. Endocrinol Metab Clin North Am 1987;16(3):705–730.

    PubMed  CAS  Google Scholar 

  105. Lamberts S WJ, Klijn JGM, deJong FH. The definition of true recurrence of pituitary-dependent Cushing’s syndrome after transsphenoidal operation. Clin Endocrinol (Oxford) 1987;26:707–712.

    CAS  Google Scholar 

  106. Ram Z, Nieman LK, Cutler GB, Chrousos GP, Doppman JL, Oldfield EH. Early repeat surgery for persistent Cushing’s disease. J Neurosurg 1994;80:37–45.

    PubMed  CAS  Google Scholar 

  107. Sonino N, Zielezny M, Fava GA, Fallo F, Boscaro M. Risk factors and long-term outcome in pituitary-dependent Cushing’s disease. J Clin Endocrinol Metab 1996;81:2647–2652.

    PubMed  CAS  Google Scholar 

  108. Tindall GT, Herring CJ, Clark RV, Adams DA, Watts NB. Cushing’s disease: Results of transsphenoidal microsurgery with emphasis on surgical failures. J Neurosurg 1990;72:363–369.

    PubMed  CAS  Google Scholar 

  109. Robert F, Hardy J. Cushing’s disease: A correlation of radiological, surgical and pathological findings with therapeutic results. Pathol Res Pract 1991;187:617–621.

    PubMed  CAS  Google Scholar 

  110. Tahir AH, Sheeler LR. Recurrent Cushing’s disease after transsphenoidal surgery. Arch Intern Med 1992;152:977–981.

    PubMed  CAS  Google Scholar 

  111. Olson BR, Rubino D, Gumowski J, Oldfield EH. Isolated hyponatremia after transsphenoidal pituitary surgery. J Clin Endocrinol Metab 1995;80:85–91.

    PubMed  CAS  Google Scholar 

  112. Friedman RB, Oldfield EH, Nieman LK, Chrousos GP, Doppman JL, Cutler GB, et al. Repeat transsphenoidal surgery for Cushing’s disease. J Neurosurg 1989;71:520–527.

    PubMed  CAS  Google Scholar 

  113. Halberg FE, Sheline GE. Radiotherapy of pituitary tumors. Endocrinol Metab Clin North Am 1987;16(3):667–684.

    PubMed  CAS  Google Scholar 

  114. Orth DN, Liddle GW. Results of treatment in 108 patients with Cushing’s syndrome. N Engl J Med 1971;285:243–247.

    PubMed  CAS  Google Scholar 

  115. Larson DA. Radiation therapy of pituitary tumors. In: Youmans JR, ed. Neurological Surgery. W.B. Saunders, Philadelphia, 1996, pp. 2970–2979.

    Google Scholar 

  116. Flickinger JC, Rush SC. Linear accelerator therapy of pituitary adenomas. In: Landolt AM, Vance ML, Reilly PL, eds. Pituitary Adenomas. Churchill-Livingstone, New Jersey, 1996, pp. 475–483.

    Google Scholar 

  117. Howlett TA, Plowman PN, Wass JAH, Rees LH, Jones AE, Besser GM. Megavoltage pituitary irradiation in the management of Cushing’s disease and Nelson’s syndrome: Long-term follow-up. Clin Endocrinol (Oxford) 1989;31:309–323.

    CAS  Google Scholar 

  118. Hughes MN, Llamas KJ, Yelland ME, Tripcony LB. Pituitary adenomas: Long-term results for radiotherapy alone and post-operative radiotherapy. Int J Radiat Oncol Biol Phys 1993;27:1035–1043.

    PubMed  CAS  Google Scholar 

  119. Littley MD, Shalet SM, Beardwell CG, Ahmed SR, Sutton ML. Long-term follow-up of low-dose external pituitary irradiation for Cushing’s disease. Clin Endocrinol (Oxford) 1990;33:445–455.

    CAS  Google Scholar 

  120. Ahmed SR, Shalet SM, Beardwell CG, Sutton ML. Treatment of Cushing’s disease with low dose radiation therapy. Br Med J 1984;289:643–646.

    CAS  Google Scholar 

  121. Vincente A, Estrada J, de la Cuerda C, Astigarraga B, Marazuela M, Blanco C, et al. Results of external pituitary irradiation after unsuccessful transsphenoidal surgery in Cushing’s disease. Acta Endocrinol (Copenh) 1991;125:470–474.

    Google Scholar 

  122. Estrada J, Boronat M, Mielgo M, Magallon R, Millan I, Diez S, et al. The long-term outcome of pituitary irradiation after unsuccessful transsphenoidal surgery in Cushing’s disease. N Engl J Med 1997;336:172–177.

    PubMed  CAS  Google Scholar 

  123. Clarke SD, Woo SY, Butler EB, Dennis WS, Lu H, Carpenter LS, et al. Treatment of secretory pituitary adenoma with radiation therapy. Radiology 1993;188:759–763.

    PubMed  CAS  Google Scholar 

  124. Murayama M, Yasuda K, Minamori Y, Mercado-Asis LB, Yamakita N, Miura K. Long term follow-up of Cushing’s disease treated with reserpine and pituitary irradiation. J Clin Endocrinol Metab 1992;75:935–942.

    PubMed  CAS  Google Scholar 

  125. Ross WM, Evered DC, Hunter P, Benaim M, Cook D, Hall R. Treatment of Cushing’s disease with adrenal blocking drugs and megavoltage therapy to the pituitary. Clin Radiol 1979;30: 149–153.

    PubMed  CAS  Google Scholar 

  126. Snyder PJ, Fowble BF, Schatz NJ, Savino PJ, Gennarelli TA. Hypopituitarism following radiation therapy of pituitary adenomas. Am J Med 1986;81:457–462.

    PubMed  CAS  Google Scholar 

  127. Littley MD, Shalet SM, Beardwell CG, Ahmed SR, Applegate G, Sutton ML. Hypopituitarism following external radiotherapy for pituitary tumors in adults. Q J Med 1989;(70)262:145–160.

    Google Scholar 

  128. Kjellberg RN, Kliman B, Swisher B, Butler W. Proton beam therapy of Cushing’s disease and Nelson’s syndrome. In: Black PM, Zervas NT, Ridgway EC, Martin JB, eds. Secretory Tumors of the Pituitary Gland. Raven, New York, 1984, pp. 294–307.

    Google Scholar 

  129. Degerblad M, Rahn T, Bergstrand G, Thoren M. Long-term results of stereotactic radiosurgery to the pituitary gland in Cushing’s disease. Acta Endocrinol (Copenh) 1986;112:310–314.

    CAS  Google Scholar 

  130. Rahn T, Thoren M, Werner S. Stereotactic radiosurgery in pituitary adenomas. In: Faglia G, Beck-Peccoz P, Ambrosi B, Travaglini P, Spada A, eds. Pituitary Adenomas: New Trends in Basic and Clinical Research. Elsevier Science, New York, 1991 pp.303–312.

    Google Scholar 

  131. Ganz JC. Gamma knife treatment of pituitary adenomas. In Landolt AM, Vance ML, Reilly PL, eds. Pituitary Adenomas. Churchill-Livingstone, New Jersey, 1996, pp. 461–474.

    Google Scholar 

  132. Sandler LM, Richards NT, Carr DH, Mashiter K, Joplin GF. Long term follow-up of patients with Cushing’s disease treated by interstitial irradiation. J Clin Endocrinol Metab 1987;65:441–447.

    PubMed  CAS  Google Scholar 

  133. Burke CW, Doyle FH, Joplin GF, Arnot RN, Macerlean DP, Fraser TR. Cushing’s disease: Treatment by pituitary implantation of radioactive gold or yttrium seeds. Q J Med 1973;42(168):693–714.

    PubMed  CAS  Google Scholar 

  134. Pont A, Williams PL, Loose DS, Feldman D, Reitz RE, Bochra C, et al. Ketoconazole blocks adrenal steroid synthesis. Ann Intern Med 1982;97:370–372.

    PubMed  CAS  Google Scholar 

  135. Sonino N. The use of ketoconazole as an inhibitor of steroid production. N Eng J Med 1987;317:812–818.

    CAS  Google Scholar 

  136. Sonino N, Boscaro M, Merola G, Mantero F. Prolonged treatment of Cushing’s disease by ketoconazole. J Clin Endocrinol Metab 1985;61:718–722.

    PubMed  CAS  Google Scholar 

  137. Engelhardt D, Weber MM. Therapy of Cushing’s syndrome with steroid biosynthesis inhibitors. J Steroid Biochem Mol Biol 1994;49:261–267.

    PubMed  CAS  Google Scholar 

  138. Trainer PJ, Besser M. Cushing’s syndrome: Therapy directed at the adrenal glands. Endocrinol Metab Clin North Am 1994;23(3): 571–584.

    PubMed  CAS  Google Scholar 

  139. Duarte PA, Chow CC, Simmons F, Ruskin J. Fatal hepatitis associated with ketoconazole therapy. Arch Intern Med 1984; 144: 1069–1070.

    PubMed  CAS  Google Scholar 

  140. Liddle GW, Estep HL, Kendall JW, Williams WC, Townes AW. Clinical application of a new test of pituitary reserve. J Clin Endocrinol Metab 1959;19:875–894.

    PubMed  CAS  Google Scholar 

  141. Jeffcoate WJ, Rees LH, Tomlin S, Jones AE, Edwards CRW, Besser GM. Metyrapone in long-term management of Cushing’s disease. Br Med J 1977;2:215–217.

    PubMed  CAS  Google Scholar 

  142. Verhelst JA, Trainer PJ, Howlett TA, Perry L, Rees LH, Grossman AB, et al. Short and long-term responses to metyrapone in the medical management of 91 patients with Cushing’s syndrome. Clin Endocrinol (Oxford) 1991;35:169–178.

    CAS  Google Scholar 

  143. Thoren M, Adamson U, Sjoberg HE. Aminoglutethimide and metyrapone in the management of Cushing’s syndrome. Acta Endocrinol (Copenh) 1985;109:451–457.

    CAS  Google Scholar 

  144. Sonino N, Boscaro M, Ambroso G, Merola G, Mantero F. Prolonged treatment of Cushing’s disease with metyrapone and aminoglutethimide. IRCS Med Sci 1986;14:485–486.

    Google Scholar 

  145. Miller JW, Crapo L. The medical treatment of Cushing’s syndrome. Endocr Rev 1993;14:443–458.

    PubMed  CAS  Google Scholar 

  146. Nelson AA, Woodard G. Severe adrenal cortical atrophy (cytotoxic) and hepatic damage produced in dogs by feeding 2,2-bis(parachlorophenyl)-1,1-dichloroethane (DDD or TDE). Arch Pathol 1949;48:387–394.

    CAS  Google Scholar 

  147. Southren AL, Weisenfeld S, Laufer A, Goldner MG. Effect of o,p’DDD in a patient with Cushing’s syndrome. J Clin Endocrinol Metab 1961;21:201–208.

    CAS  Google Scholar 

  148. Sonino N. Medical treatment: Inhibitors of adrenal steroid production. J Endocrinol Invest 1992;15:234–235.

    Google Scholar 

  149. Luton JP, Mahoudeau JA, Bouchard P, Thieblot P, Hautecouverture M, Simon D, et al. Treatment of Cushing’s disease by o,p’DDD: Survey of 62 cases. N Engl J Med 1979;300:459–464.

    PubMed  CAS  Google Scholar 

  150. Schulte HM, Benker G, Reinwein D, Sippell WG, Allolio B. Infusion of low dose etomidate: Correction of hypercortisolemia in patients with Cushing’s syndrome and dose-response relationship in normal subjects. J Clin Endocrinol Metab 1990;70:1426–1430.

    PubMed  CAS  Google Scholar 

  151. Wagner RL, White PF, Kan PB, Rosenthal MH, Feldman D. Inhibition of adrenal steroidogenesis by the anesthetic etomidate. N Engl J Med 1984;310:1415–1421.

    PubMed  CAS  Google Scholar 

  152. Dewis P, Anderson DC, Bu’lock DE, Earnshaw R, Kelly WF. Experience with trilostane in the treatment of Cushing’ s syndrome. Clin Endocrinol (Oxford) 1983;18:533–540.

    CAS  Google Scholar 

  153. Komanicky P, Spark RF, Melby JC. Treatment of Cushing’s syndrome with trilostane (WIN 24,540), an inhibitor of adrenal steroid biosynthesis. J Clin Endocrinol Metab 1978;47:1042–1051.

    PubMed  CAS  Google Scholar 

  154. Nieman LK, Chrousos GP, Kellner C, Spitz IM, Nisula BC, Cutler GB, et al. Successful treatment of Cushing’s syndrome with the glucocorticoid antagonist RU 486. J Clin Endocrinol Metab 1985;61:536–540.

    PubMed  CAS  Google Scholar 

  155. Vignati F, Loli P. Additive effect of ketoconazole and octreotide in the treatment of severe adrenocorticotropin-dependent hypercortisolism. J Clin Endocrinol Metab 1999;81:2885–2890.

    Google Scholar 

  156. Besser GM, Edwards CRW. Cushing’s syndrome. Clin Endocrinol Metab 1972;1:451–490.

    Google Scholar 

  157. Scott HW, Liddle GW, Mulherin JL, McKenna TJ, Stroup SL, Rhamy RK. Surgical experience with Cushing’s disease. Ann Surg 1977;185:524–534.

    PubMed  Google Scholar 

  158. Jenkins PJ, Trainer PJ, Plowman PN, Shand WS, Grossman AB, Wass JAH, et al. The long term outcome after adrenalectomy and prophylactic pituitary radiotherapy in adrenocorticotropin-dependent Cushing’s syndrome. J Clin Endocrinol Metab 1995;80:165–171.

    PubMed  CAS  Google Scholar 

  159. McCance DR, Russell CFJ, Kennedy TL, Hadden DR, Kennedy L, Atkinson AB. Bilateral adrenalectomy: low mortality and morbidity in Cushing’s disease. Clin Endocrinol (Oxford) 1993;39:315–321.

    CAS  Google Scholar 

  160. Welbourn RB. Survival and causes of death after adrenalectomy for Cushing’s disease. Surgery 1985;97:16–20.

    PubMed  CAS  Google Scholar 

  161. Bax TW, Marcus DR, Galloway GQ, Swanstrom LL, Sheppard BC. Laparoscopic bilateral adrenalectomy following failed hypo-physectomy. Surg Endosc 1996;10:1150–1153.

    PubMed  CAS  Google Scholar 

  162. Gagner M. Laparoscopic adrenalectomy. Surg Clin North Am 1996;76(3):523–537.

    PubMed  CAS  Google Scholar 

  163. O’Riordain DS, Farley DR, Young WF, Grand CS, van Heerdan JA. Long-term outcome of bilateral adrenalectomy in patients with Cushing’s syndrome. Surgery 1994;116:1088–1094.

    PubMed  Google Scholar 

  164. Schteingart DE, Conn JW, Lieberman LM, Beierwaltes WH. Persistent or recurrent Cushing’s syndrome after “total” adrenalectomy. Arch Intern Med 1972;130:384–387.

    PubMed  CAS  Google Scholar 

  165. Kelly WF, MacFarlane IA, Longson D, Davies D, Sutcliffe H. Cushing’s disease treated by total adrenalectomy: Long-term observations of 43 patients. Q J Med 1983;52(206):224–231.

    PubMed  CAS  Google Scholar 

  166. Kemink L, Hermus A, Pieters G, Benraad T, Smals A, Kloppenborg P. Residual adrenocortical function after bilateral adrenalectomy for pituitary-dependent Cushing’s syndrome. J Clin Endocrinol Metab 1992;75:1211–1214.

    PubMed  CAS  Google Scholar 

  167. Kasperlik-Zaluska AA, Nielubowicz J, Wislawski J, Hartwig W, Zaluska J, Jeske W, et al. Nelson’s syndrome: incidence and prognosis. Clin Endocrinol (Oxford) 1983;19:693–698.

    CAS  Google Scholar 

  168. Wislawski J, Kasperlik-Zaluska AA, Jeske W, Migdalska B, Janik J, Zaluska J, et al. Results of neurosurgical treatment by a transsphenoidal approach in 10 patients with Nelson’s syndrome. J Neurosurg 1985;62:68–71.

    PubMed  CAS  Google Scholar 

  169. Nelson DH, Meakin JW, Dealy JB, Matson DD, Emerson K, Thorn GW. ACTH-producing tumor of the pituitary gland. New Engl J Med 1958;259:161–164.

    PubMed  CAS  Google Scholar 

  170. Nelson DH, Meakin JW, Thorn GW. ACTH-producing pituitary tumors following adrenalectomy for Cushing’s syndrome. Ann Intern Med 1960;52:560–569.

    PubMed  CAS  Google Scholar 

  171. Karl M, von Wichert G, Kempter E, Katz DA, Reincke M, Monig H, et al. Nelson’s syndrome associated with a somatic frame shift mutation in the glucocorticoid receptor gene. J Clin Endocrinol Metab 1996;81:124–129.

    PubMed  CAS  Google Scholar 

  172. Grua JR, Nelson DH. ACTH-producing pituitary tumors. Endocrinol Metab Clin North Am 1991 ;20(2):319–362.

    PubMed  CAS  Google Scholar 

  173. Moore TJ, Dluhy RG, Williams GH, Caine JP. Nelson’s syndrome: Frequency, prognosis, and effect of prior pituitary irradiation. Ann Intern Med 1976;85:731–734.

    PubMed  CAS  Google Scholar 

  174. Weinstein M, Tyrrell B, Newton TH. The sella turcica in Nelson’s syndrome. Radiology 1976;118:363–365.

    PubMed  CAS  Google Scholar 

  175. Miller WM, Tyrrell JB. The adrenal cortex. In: Felig P, Baxter JD, Frohman LA, eds. Endocrinology and Metabolism. McGraw-Hill, New York, 1995, pp. 555–711.

    Google Scholar 

  176. Cohen KL, Noth RH, Pechinski T. Incidence of pituitary tumors following adrenalectomy. Arch Intern Med 1978;138:575–579.

    PubMed  CAS  Google Scholar 

  177. Kemink L, Pieters G, Hermus A, Smals A, Kloppenborg P. Patient’s age is a simple predictive factor for the development of Nelson’s syndrome after total adrenalectomy for Cushing’s disease. J Clin Endocrinol Metab 1994;79:887–889.

    PubMed  CAS  Google Scholar 

  178. Barnett AH, Livesey JH, Friday K, Donald RA, Espiner EA. Comparison of preoperative ACTH concentrations after bilateral adrenalectomy in Cushing’s disease. Clin Endocrinol (Oxford) 1983;18:301–305.

    CAS  Google Scholar 

  179. Moreira AC, Castro M, Machado HR. Longitudinal evaluation of adrenocorticotrophin and p-lipotrophin plasma levels following bilateral adrenalectomy in patients with Cushing’s disease. Clin Endocrinol (Oxford) 1993;39:91–96.

    CAS  Google Scholar 

  180. Hopwood NJ, Kenny FM. Incidence of Nelson’s syndrome after adrenalectomy for Cushing’s disease in children. Am J Dis Child 1977;131:1353–1356.

    PubMed  CAS  Google Scholar 

  181. Thomas CG, Smith AT, Benson M, Griffith J. Nelson’s syndrome after Cushing’s disease in childhood: A continuing problem. Surgery 1984;96:1067–1077.

    Google Scholar 

  182. Cassar J, Doyle FH, Lewis PD, Mashiter K, Noorden SV, Joplin GH. Treatment of Nelson’s syndrome by pituitary implantation of yttrium-90 or gold-198. Br Med J 1976;2: 269–272.

    PubMed  CAS  Google Scholar 

  183. Wild W, Nicolis GL, Gabrilove JL. Appearance of Nelson’s syndrome despite pituitary irradiation prior to bilateral adrenalectomy for Cushing’s syndrome. Mt. Sinai J Med 1972;40: 68–71.

    Google Scholar 

  184. Scheithauer BW, Kovacs KT, Laws ER, Randall RV. Pathology of invasive pituitary tumors with special reference to functional classification. J Neurosurg 1986;65:733–744.

    PubMed  CAS  Google Scholar 

  185. Verdonk C, Guerin C, Lufkin E, Hodgson SF. Activation of virilizing adrenal rest tissues by excessive ACTH production. Am J Med 1982;73:455–459.

    PubMed  CAS  Google Scholar 

  186. Baranetsky NG, Zipser RD, Goebelsmann U, Kurman RJ, March CM, Morimoto I, et al. Adrenocorticotropin-dependent virilizing paraovarian tumors in Nelson’s syndrome. J Clin Endocrinol Metab 1979;49:381–386.

    PubMed  CAS  Google Scholar 

  187. Hamwi GJ, Gwinup G, Mostow JH, Besch PK. Activation of testicular adrenal rest tissue by prolonged excessive ACTH production. J Clin Endocrinol Metab 1963;23:861–869.

    PubMed  CAS  Google Scholar 

Download references

Authors
  1. Joan C. Lo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Blake Tyrrell MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Charles B. Wilson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Division of Neurosurgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada

    Kamal Thapar MD, PhD

  2. Department of Pathology and Laboratory Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada

    Kalman Kovacs MD, PhD

  3. Department of Pathology, Mayo Clinic, Rochester, MN, USA

    Bernd W. Scheithauer MD  & Ricardo V. Lloyd MD, PhD  & 

Rights and permissions

Reprints and permissions

Copyright information

© 2001 Springer Science+Business Media New York

About this chapter

Cite this chapter

Lo, J.C., Tyrrell, J.B., Wilson, C.B. (2001). Corticotroph Adenomas. In: Thapar, K., Kovacs, K., Scheithauer, B.W., Lloyd, R.V. (eds) Diagnosis and Management of Pituitary Tumors. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-217-3_18

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-217-3_18

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4684-9693-2

  • Online ISBN: 978-1-59259-217-3

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation