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Five cases of cyclical Cushing's syndrome.

1985; BMJ; Volume: 291; Issue: 6507 Linguagem: Inglês

10.1136/bmj.291.6507.1453

0959-8138

A. B. Atkinson, Adele Kennedy, David Carson, D. R. Hadden, J. A. Weaver, B. Sheridan,

Pituitary Gland Disorders and Treatments

Reported cases of cyclical Cushing9s syndrome are rare. Of 14 successive patients with Cushing9s syndrome nine collected sequential urine samples for the estimation of cortisol:creatinine ratio. Five had cyclical Cushing9s syndrome while two had considerable variation in urinary cortisol excretion without a cyclical pattern being established. Two of the five patients with a cyclical syndrome had paradoxical responses to dexamethasone. In only one patient with a cyclical pattern did the cortisol:creatinine ratio fall after treatment with bromocriptine or cyproheptadine, or both. The high incidence of the cyclical form of Cushing9s syndrome has important clinical implications. A high index of suspicion of the syndrome is required in patients with symptoms or signs of Cushing9s syndrome but with normal cortisol values, in patients with fluctuating cortisol values, and in patients with anomalous responses to dexamethasone. Because of possible variations in steroidogenesis the results of drug studies in Cushing9s syndrome must be interpreted cautiously.