New Causes of Cushing's Syndrome

Spontaneous Cushing's syndrome is usually divided into that which is dependent on corticotropin and that which is not. In the first category are Cushing's disease, the ectopic corticotropin syndrome, and the very rare ectopic corticotropin-releasing—hormone syndrome; in the second are cortisol-producing unilateral adrenocortical adenomas and carcinomas. Occasional patients with apparently autonomous, corticotropin-independent overproduction of cortisol unexpectedly have evidence of bilateral adrenocortical involvement: the two glands are generally but not always enlarged and most often multinodular, and the histologic appearance of intervening nonnodular cortex is variously described as atrophic, normal, or hyperplastic. This intriguing and ill-defined disorder has received much attention, . . .