A. Cushing’s Syndrome
This disorder is caused by either an ACTH-dependent adenoma or an ACTH-independent adenoma. Cushing’s disease in greater than 70% of the cases is caused by ectopic ACTH syndrome, and 10% percent of the time it is caused by an ectopic corticotropin-releasing hormone. An ACTH-independent adrenal adenoma causes Cush-ing’s syndrome in 10% of cases, it is caused by adrenal carcinoma in 10% of the cases, and rarely it is seen in micronodular adrenal diseases and during iatrogenic exogenous glucocorticoid administration.
1. Clinical Manifestations
These manifestations include a characteristic form of truncal obesity which involves the abdomen, chest, and the upper back causing a buffalo hump. The upper and lower limbs are thin and some wasting and weakness of the upper thigh muscles (the quadriceps) occurs. Because of this, the patient has difficulty climbing stairs.
Cardiovascular complications such as hypertension may be severe. Diabetes may occur and along with hypertension this increases the risk for myocardial infarction. Acceler¬ated atherosclerosis is a common finding in patients not treated early in the course of this disease.
2. Management
Cushing’s disease requires transsphenoidal pituitary surgery and adrenal tumors require adrenalectomy. Ectopic ACTH syndrome occurs and requires treatment of the underlying tumor. Correction of hypokalemia with potassium replacement and spironolactone and drugs that block steroid synthesis may be also be required.

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