ENDOTEXT Series: Staying Current in Endocrinology " Cushing's Disease"
Cushing’s Syndrome results from chronic exposure to excessive circulating levels of glucocorticoids. It is now one hundred years since Harvey Cushing reported the classical clinical syndrome that bears his name. Even now its investigation and management can vex the most experienced endocrinologist. It may be difficult to miss the diagnosis in its most florid form. But, given the high prevalence of many of its non-specific symptoms such as obesity, muscle weakness and depression, clinicians are now considering the diagnosis in its earlier manifestations. The plethora of investigations often needed for the diagnosis and differential diagnosis has grown over the intervening century, and require careful interpretation. In its severe form and when untreated, the metabolic upset of Cushing’s syndrome is associated with a high mortality. Yet, more subtle excesses of cortisol may also have significant effects on glycaemic control and blood pressure, and may therefore be an important cause of morbidity. Treatment is often complex and may require all the modalities of surgery, radiotherapy and medical management.
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