FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 332:791-803 March 23, 1995 Number 12 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

	Full Text PDF Purchase this article Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article PubMed Citation

Harvey W. Cushing's 1932 description¹ of the syndrome that results from long-term exposure to glucocorticoids has not been improved upon, but our understanding of its pathophysiologic features and our ability to diagnose and treat the disorder have increased dramatically.

Normal Hypothalamic–Pituitary–Adrenal Physiology

Corticotropin-releasing hormone (CRH)² is synthesized in the hypothalamus and carried to the anterior pituitary in portal blood (Figure 1). CRH, whose secretion is regulated by a variety of neurotransmitters,³ is the most potent regulator of corticotropin secretion. Arginine vasopressin and other hypothalamic agents also stimulate corticotropin secretion.^4,5

View larger version (36K): [in this window] [in a new window]   Figure 1. Physiologic and Pathophysiologic Features of the Hypothalamic–Pituitary–Adrenal Axis in Normal Subjects and . . . [Full Text of this Article]

 
Pathophysiologic Features of Cushing's Syndrome

Corticotropin-Dependent Cushing's Syndrome

            Cushing's Disease

            Ectopic Corticotropin Syndrome

            Ectopic CRH Syndrome

            Pseudo–Cushing's Syndrome

Corticotropin-Independent Cushing's Syndrome

            Adrenocortical Tumors

            Bilateral Micronodular Hyperplasia

            Bilateral Macronodular Hyperplasia

Diagnosis

Diagnosis of Cushing's Syndrome

            Clinical Diagnosis

            Laboratory Confirmation

Distinguishing between Corticotropin-Dependent and Corticotropin-Independent Cushing's Syndrome

Determining the Source of Excess Corticotropin Secretion

            High-Dose Dexamethasone Suppression Tests

            Metyrapone Stimulation Test

            Petrosal Venous Sinus Catheterization

Determining the Source of Corticotropin in Patients Whose Hypersecretion Cannot Be Suppressed with Dexamethasone

Imaging Procedures

Role of the CRH Stimulation Test

Treatment

Cushing's Disease

Ectopic Corticotropin and CRH Syndromes

Primary Adrenal Disease

Summary

Source Information

From the Division of Endocrinology, Department of Medicine, Vanderbilt Medical Center North, Nashville.

References

This article has been cited by other articles:

• Reddy, T. E., Pauli, F., Sprouse, R. O., Neff, N. F., Newberry, K. M., Garabedian, M. J., Myers, R. M. (2009). Genomic determination of the glucocorticoid response reveals unexpected mechanisms of gene regulation. Genome Res 19: 2163-2171 [Abstract] [Full Text]  
• Boscaro, M., Ludlam, W. H., Atkinson, B., Glusman, J. E., Petersenn, S., Reincke, M., Snyder, P., Tabarin, A., Biller, B. M. K., Findling, J., Melmed, S., Darby, C. H., Hu, K., Wang, Y., Freda, P. U., Grossman, A. B., Frohman, L. A., Bertherat, J. (2009). Treatment of Pituitary-Dependent Cushing's Disease with the Multireceptor Ligand Somatostatin Analog Pasireotide (SOM230): A Multicenter, Phase II Trial. J. Clin. Endocrinol. Metab. 94: 115-122 [Abstract] [Full Text]  
• Kjeldsen, S. E., Aksnes, T. A., Fagard, R. H., Mancia, G. (2009). CHAPTER 13 Hypertension. ESC Textbook of Cardiovascular Medicine 2: med-9780199566990-chapter-med-9780199566990-chapter [Abstract] [Full Text]  
• Sai, S., Esteves, C. L., Kelly, V., Michailidou, Z., Anderson, K., Coll, A. P., Nakagawa, Y., Ohzeki, T., Seckl, J. R., Chapman, K. E. (2008). Glucocorticoid Regulation of the Promoter of 11{beta}-Hydroxysteroid Dehydrogenase Type 1 Is Indirect and Requires CCAAT/Enhancer-Binding Protein-{beta}. Mol. Endocrinol. 22: 2049-2060 [Abstract] [Full Text]  
• de Bruin, C., Hanson, J. M., Meij, B. P., Kooistra, H. S., Waaijers, A. M., Uitterlinden, P., Lamberts, S. W. J., Hofland, L. J. (2008). Expression and Functional Analysis of Dopamine Receptor Subtype 2 and Somatostatin Receptor Subtypes in Canine Cushing's Disease. Endocrinology 149: 4357-4366 [Abstract] [Full Text]  
• Patil, C. G., Prevedello, D. M., Lad, S. P., Vance, M. L., Thorner, M. O., Katznelson, L., Laws, E. R. Jr. (2008). Late Recurrences of Cushing's Disease after Initial Successful Transsphenoidal Surgery. J. Clin. Endocrinol. Metab. 93: 358-362 [Abstract] [Full Text]  
• Remer, T., Dimitriou, T., Maser-Gluth, C. (2008). Renal Net Acid Excretion and Plasma Leptin Are Associated with Potentially Bioactive Free Glucocorticoids in Healthy Lean Women. J. Nutr. 138: 426S-430S [Abstract] [Full Text]  
• Hayashi, N., Kurimoto, M., Kubo, M., Kuwayama, N., Kurosaki, K., Nagai, S., Endo, S. (2008). The Impact of Cavernous Sinus Drainage Pattern on the Results of Venous Sampling in Patients With Suspected Cushing Syndrome. Am. J. Neuroradiol. 29: 69-72 [Abstract] [Full Text]  
• Pecori Giraldi, F., Ambrogio, A. G., De Martin, M., Fatti, L. M., Scacchi, M., Cavagnini, F. (2007). Specificity of First-Line Tests for the Diagnosis of Cushing's Syndrome: Assessment in a Large Series. J. Clin. Endocrinol. Metab. 92: 4123-4129 [Abstract] [Full Text]  
• Remer, T., Maser-Gluth, C. (2007). Simultaneous Measurements of Urinary Free Cortisol and Cortisone for the Assessment of Functional Glucocorticoid Activity. Clin. Chem. 53: 1870-1871 [Full Text]  
• Wudy, S. A., Hartmann, M. F., Remer, T. (2007). Sexual dimorphism in cortisol secretion starts after age 10 in healthy children: urinary cortisol metabolite excretion rates during growth. Am. J. Physiol. Endocrinol. Metab. 293: E970-E976 [Abstract] [Full Text]  
• Meinardi, J R, Wolffenbuttel, B H R, Dullaart, R P F (2007). Cyclic Cushing's syndrome: a clinical challenge. Eur J Endocrinol 157: 245-254 [Abstract] [Full Text]  
• Castinetti, F, Morange, I, Dufour, H, Jaquet, P, Conte-Devolx, B, Girard, N, Brue, T (2007). Desmopressin test during petrosal sinus sampling: a valuable tool to discriminate pituitary or ectopic ACTH-dependent Cushing's syndrome. Eur J Endocrinol 157: 271-277 [Abstract] [Full Text]  
• Batista, D. L., Riar, J., Keil, M., Stratakis, C. A. (2007). Diagnostic Tests for Children Who Are Referred for the Investigation of Cushing Syndrome. Pediatrics 120: e575-e586 [Abstract] [Full Text]  
• Batista, D. L., Zhang, X., Gejman, R., Ansell, P. J., Zhou, Y., Johnson, S. A., Swearingen, B., Hedley-Whyte, E. T., Stratakis, C. A., Klibanski, A. (2006). The Effects of SOM230 on Cell Proliferation and Adrenocorticotropin Secretion in Human Corticotroph Pituitary Adenomas. J. Clin. Endocrinol. Metab. 91: 4482-4488 [Abstract] [Full Text]  
• Weil, R. J., Vortmeyer, A. O., Nieman, L. K., DeVroom, H. L., Wanebo, J., Oldfield, E. H. (2006). Surgical Remission of Pituitary Adenomas Confined to the Neurohypophysis in Cushing's Disease. J. Clin. Endocrinol. Metab. 91: 2656-2664 [Abstract] [Full Text]  
• Prabhakar, V K B, Shalet, S M (2006). Aetiology, diagnosis, and management of hypopituitarism in adult life.. Postgrad. Med. J. 82: 259-266 [Abstract] [Full Text]  
• Oltmanns, K. M, Dodt, B., Schultes, B., Raspe, H. H, Schweiger, U., Born, J., Fehm, H. L, Peters, A. (2006). Cortisol correlates with metabolic disturbances in a population study of type 2 diabetic patients. Eur J Endocrinol 154: 325-331 [Abstract] [Full Text]  
• Faggiano, A., Melis, D., Alfieri, R., De Martino, M., Filippella, M., Milone, F., Lombardi, G., Colao, A., Pivonello, R. (2005). Sulfur Amino Acids in Cushing's Disease: Insight in Homocysteine and Taurine Levels in Patients with Active and Cured Disease. J. Clin. Endocrinol. Metab. 90: 6616-6622 [Abstract] [Full Text]  
• Viardot, A., Huber, P., Puder, J. J., Zulewski, H., Keller, U., Muller, B. (2005). Reproducibility of Nighttime Salivary Cortisol and Its Use in the Diagnosis of Hypercortisolism Compared with Urinary Free Cortisol and Overnight Dexamethasone Suppression Test. J. Clin. Endocrinol. Metab. 90: 5730-5736 [Abstract] [Full Text]  
• Vu, L., Theodore, P. R. (2005). Localization of a Corticotropin-Secreting Tumor by Thoracoscopic Pulmonary Venous Sampling. NEJM 353: 851-852 [Full Text]  
• Pivonello, R., Ferone, D., Lamberts, S. W.J., Colao, A. (2005). Cabergoline plus Lanreotide for Ectopic Cushing's Syndrome. NEJM 352: 2457-2458 [Full Text]  
• Zervolea, I., Pratsinis, H., Tsagarakis, S., Karavitaki, N., Stathakos, D., Thalassinos, N., Kletsas, D. (2005). The impact of chronic in vivo glucocorticoid excess on the functional characteristics of human skin fibroblasts obtained from patients with endogenous Cushing's syndrome. Eur J Endocrinol 152: 895-902 [Abstract] [Full Text]  
• Bower, A. N, Oyen, L. J (2005). Interaction Between Dexamethasone Treatment and the Corticotropin Stimulation Test in Septic Shock. The Annals of Pharmacotherapy 39: 335-338 [Abstract] [Full Text]  
• Hammer, G. D., Tyrrell, J. B., Lamborn, K. R., Applebury, C. B., Hannegan, E. T., Bell, S., Rahl, R., Lu, A., Wilson, C. B. (2004). Transsphenoidal Microsurgery for Cushing's Disease: Initial Outcome and Long-Term Results. J. Clin. Endocrinol. Metab. 89: 6348-6357 [Abstract] [Full Text]  
• Miehle, K., Tannapfel, A., Lamesch, P., Borte, G., Schenker, E., Kluge, R., Ott, R. A., Wiechmann, V., Koch, M., Kassahun, W., Paschke, R., Koch, C. A. (2004). Pancreatic Neuroendocrine Tumor with Ectopic Adrenocorticotropin Production upon Second Recurrence. J. Clin. Endocrinol. Metab. 89: 3731-3736 [Abstract] [Full Text]  
• Pivonello, R., Ferone, D., de Herder, W. W., Kros, J. M., Del Basso De Caro, M. L., Arvigo, M., Annunziato, L., Lombardi, G., Colao, A., Hofland, L. J., Lamberts, S. W. J. (2004). Dopamine Receptor Expression and Function in Corticotroph Pituitary Tumors. J. Clin. Endocrinol. Metab. 89: 2452-2462 [Abstract] [Full Text]  
• Rollin, G. A. F. S., Ferreira, N. P., Junges, M., Gross, J. L., Czepielewski, M. A. (2004). Dynamics of Serum Cortisol Levels after Transsphenoidal Surgery in a Cohort of Patients with Cushing's Disease. J. Clin. Endocrinol. Metab. 89: 1131-1139 [Abstract] [Full Text]  
• Choi, J.-W., Park, S. C., Kang, G. H., Liu, J. O., Youn, H.-D. (2004). Nur77 Activated by Hypoxia-Inducible Factor-1{alpha} Overproduces Proopiomelanocortin in von Hippel-Lindau-Mutated Renal Cell Carcinoma. Cancer Res. 64: 35-39 [Abstract] [Full Text]  
• Arnaldi, G., Angeli, A., Atkinson, A. B., Bertagna, X., Cavagnini, F., Chrousos, G. P., Fava, G. A., Findling, J. W., Gaillard, R. C., Grossman, A. B., Kola, B., Lacroix, A., Mancini, T., Mantero, F., Newell-Price, J., Nieman, L. K., Sonino, N., Vance, M. L., Giustina, A., Boscaro, M. (2003). Diagnosis and Complications of Cushing's Syndrome: A Consensus Statement. J. Clin. Endocrinol. Metab. 88: 5593-5602 [Abstract] [Full Text]  
• Isidori, A. M., Kaltsas, G. A., Mohammed, S., Morris, D. G., Jenkins, P., Chew, S. L., Monson, J. P., Besser, G. M., Grossman, A. B. (2003). Discriminatory Value of the Low-Dose Dexamethasone Suppression Test in Establishing the Diagnosis and Differential Diagnosis of Cushing's Syndrome. J. Clin. Endocrinol. Metab. 88: 5299-5306 [Abstract] [Full Text]  
• Tsagarakis, S., Christoforaki, M., Giannopoulou, H., Rondogianni, F., Housianakou, I., Malagari, C., Rontogianni, D., Bellenis, I., Thalassinos, N. (2003). A Reappraisal of the Utility of Somatostatin Receptor Scintigraphy in Patients with Ectopic Adrenocorticotropin Cushing's Syndrome. J. Clin. Endocrinol. Metab. 88: 4754-4758 [Abstract] [Full Text]  
• Loli, P., Vignati, F., Grossrubatscher, E., Dalino, P., Possa, M., Zurleni, F., Lomuscio, G., Rossetti, O., Ravini, M., Vanzulli, A., Bacchetta, C., Galli, C., Valente, D. (2003). Management of Occult Adrenocorticotropin-Secreting Bronchial Carcinoids: Limits of Endocrine Testing and Imaging Techniques. J. Clin. Endocrinol. Metab. 88: 1029-1035 [Abstract] [Full Text]  
• Pascual-Le Tallec, L., Dulmet, E., Bertagna, X., de Keyzer, Y. (2002). Identification of Genes Associated with the Corticotroph Phenotype in Bronchial Carcinoid Tumors. J. Clin. Endocrinol. Metab. 87: 5015-5022 [Abstract] [Full Text]  
• Papanicolaou, D. A., Mullen, N., Kyrou, I., Nieman, L. K. (2002). Nighttime Salivary Cortisol: A Useful Test for the Diagnosis of Cushing's Syndrome. J. Clin. Endocrinol. Metab. 87: 4515-4521 [Abstract] [Full Text]  
• Deb, A., Natt, N. (2002). 68-Year-Old Man With Generalized Weakness. Mayo Clin Proc. 77: 705-708  
• Chiodera, P., Volpi, R., Bianconcini, M., Bortesi, M. L., Manfredi, G., Coiro, V. (2002). Desmopressin Test in Occult Eutopic Corticotropin Microadenoma. Arch Intern Med 162: 840-841 [Full Text]  
• Huang, B., Wu, P., Bowker-Kinley, M. M., Harris, R. A. (2002). Regulation of Pyruvate Dehydrogenase Kinase Expression by Peroxisome Proliferator-Activated Receptor-{alpha} Ligands, Glucocorticoids, and Insulin. Diabetes 51: 276-283 [Abstract] [Full Text]  
• Estrada, J., Garcia-Uria, J., Lamas, C., Alfaro, J., Lucas, T., Diez, S., Salto, L., Barcelo, B. (2001). The Complete Normalization of the Adrenocortical Function as the Criterion of Cure after Transsphenoidal Surgery for Cushing's Disease. J. Clin. Endocrinol. Metab. 86: 5695-5699 [Abstract] [Full Text]  
• Hiroi, N., Chrousos, G. P., Kohn, B., Lafferty, A., Abu-Asab, M., Bonat, S., White, A., Bornstein, S. R. (2001). Adrenocortical-Pituitary Hybrid Tumor Causing Cushing's Syndrome. J. Clin. Endocrinol. Metab. 86: 2631-2637 [Abstract] [Full Text]  
• Korbonits, M., Bujalska, I., Shimojo, M., Nobes, J., Jordan, S., Grossman, A. B., Stewart, P. M. (2001). Expression of 11{beta}-Hydroxysteroid Dehydrogenase Isoenzymes in the Human Pituitary: Induction of the Type 2 Enzyme in Corticotropinomas and Other Pituitary Tumors. J. Clin. Endocrinol. Metab. 86: 2728-2733 [Abstract] [Full Text]  
• Newell-Price, J., King, P., Clark, A. J. L. (2001). The CpG Island Promoter of the Human Proopiomelanocortin Gene Is Methylated in Nonexpressing Normal Tissue and Tumors and Represses Expression. Mol. Endocrinol. 15: 338-348 [Abstract] [Full Text]  
• Boscaro, M., Barzon, L., Sonino, N. (2000). The Diagnosis of Cushing's Syndrome: Atypical Presentations and Laboratory Shortcomings. Arch Intern Med 160: 3045-3053 [Abstract] [Full Text]  
• Gyung Tak Sung, , Gill, I. S. (2000). Laparoscopic Adrenalectomy. SURG INNOV 7: 211-222 [Abstract]  
• White, P. C., Speiser, P. W. (2000). Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency. Endocr. Rev. 21: 245-291 [Abstract] [Full Text]  
• Wiggam, M. I., Heaney, A. P., McIlrath, E. M., McCance, D. R., Sheridan, B., Hadden, D. R., Atkinson, A. B. (2000). Bilateral Inferior Petrosal Sinus Sampling in the Differential Diagnosis of Adrenocorticotropin-Dependent Cushing's Syndrome: A Comparison with Other Diagnostic Tests. J. Clin. Endocrinol. Metab. 85: 1525-1532 [Abstract] [Full Text]  
• Mantero, F., Terzolo, M., Arnaldi, G., Osella, G., Masini, A. M., Alì, A., Giovagnetti, M., Opocher, G., Angeli, A. (2000). A Survey on Adrenal Incidentaloma in Italy. J. Clin. Endocrinol. Metab. 85: 637-644 [Abstract] [Full Text]  
• Samuels, M. H., Brandon, D. D., Isabelle, L. M., Cook, D. M., Graham, K. E., Purnell, J. Q., Loriaux, D. L. (2000). Cortisol Production Rates in Subjects with Suspected Cushing's Syndrome: Assessment by Stable Isotope Dilution Methodology and Comparison to Other Diagnostic Methods. J. Clin. Endocrinol. Metab. 85: 22-28 [Abstract] [Full Text]  
• Choyke, P. L., Doppman, J. L. (2000). Case 18: Adrenocorticotropic Hormone-dependent Cushing Syndrome1. Radiology 214: 195-198 [Full Text]  
• Freda, P. U., Wardlaw, S. L. (1999). Diagnosis and Treatment of Pituitary Tumors. J. Clin. Endocrinol. Metab. 84: 3859-3866 [Full Text]  
• Pralong, F. P., Gomez, F., Guillou, L., Mosimann, F., Franscella, S., Gaillard, R. C. (1999). Food-Dependent Cushing's Syndrome: Possible Involvement of Leptin in Cortisol Hypersecretion. J. Clin. Endocrinol. Metab. 84: 3817-3822 [Abstract] [Full Text]  
• Klee, G. G. (1999). Maximizing Efficacy of Endocrine Tests: Importance of Decision-focused Testing Strategies and Appropriate Patient Preparation. Clin. Chem. 45: 1323-1330 [Abstract] [Full Text]  
• Heaney, A., Loughrey, G., McCance, D., Mcilrath, E., Hadden, D., Kennedy, L., Sheridan, B., Atkinson, A.B. (1999). Is whole-lung CT scanning still necessary in all cases of ACTH-dependent Cushing's syndrome in the era of petrosal sinus sampling?. QJM 92: 335-340 [Abstract] [Full Text]  
• Bornstein, S. R., Stratakis, C. A., Chrousos, G. P. (1999). Adrenocortical Tumors: Recent Advances in Basic Concepts and Clinical Management. ANN INTERN MED 130: 759-771 [Abstract] [Full Text]  
• Dahia, P. L. M., Grossman, A. B. (1999). The Molecular Pathogenesis of Corticotroph Tumors. Endocr. Rev. 20: 136-155 [Abstract] [Full Text]  
• TORPY, D. J., CHEN, C. C., MULLEN, N., DOPPMAN, J. L., CARRASQUILLO, J. A., CHROUSOS, G. P., NIEMAN, L. K. (1999). Lack of Utility of 111In-Pentetreotide Scintigraphy in Localizing Ectopic ACTH Producing Tumors: Follow-Up of 18 Patients. J. Clin. Endocrinol. Metab. 84: 1186-1192 [Abstract] [Full Text]  
• Tabarin, A., Valli, N., Chanson, P., Bachelot, Y., Rohmer, V., Bex-Bachellerie, V., Catargi, B., Roger, P., Laurent, F. (1999). Usefulness of Somatostatin Receptor Scintigraphy in Patients with Occult Ectopic Adrenocorticotropin Syndrome. J. Clin. Endocrinol. Metab. 84: 1193-1202 [Abstract] [Full Text]  
• Invitti, C., Giraldi, F. P., De Martin, M., Cavagnini, F. (1999). Diagnosis and Management of Cushing's Syndrome: Results of an Italian Multicentre Study. J. Clin. Endocrinol. Metab. 84: 440-448 [Abstract] [Full Text]  
• Kaltsas, G. A., Giannulis, M. G., Newell-Price, J. D. C., Dacie, J. E., Thakkar, C., Afshar, F., Monson, J. P., Grossman, A. B., Besser, G. M., Trainer, P. J. (1999). 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. 84: 487-492 [Abstract] [Full Text]  
• DE HERDER, W W, LAMBERTS, S W J (1999). Octapeptide somatostatin-analogue therapy of Cushing's syndrome. Postgrad. Med. J. 75: 65-66 [Full Text]  
• Newell-Price, J., Trainer, P., Besser, M., Grossman, A. (1998). The Diagnosis and Differential Diagnosis of Cushing's Syndrome and Pseudo-Cushing's States. Endocr. Rev. 19: 647-672 [Abstract] [Full Text]  
• Remer, T., Pietrzik, K., Manz, F. (1998). Short-Term Impact of a Lactovegetarian Diet on Adrenocortical Activity and Adrenal Androgens. J. Clin. Endocrinol. Metab. 83: 2132-2137 [Abstract] [Full Text]  
• Papanicolaou, D. A., Yanovski, J. A., Cutler, G. B. Jr., Chrousos, G. P., Nieman, L. K. (1998). A Single Midnight Serum Cortisol Measurement Distinguishes Cushing's Syndrome from Pseudo-Cushing States. J. Clin. Endocrinol. Metab. 83: 1163-1167 [Abstract] [Full Text]  
• Young, J., Deneux, C., Grino, M., Oliver, C., Chanson, P., Schaison, G. (1998). Pitfall of Petrosal Sinus Sampling in a Cushing's Syndrome Secondary to Ectopic Adrenocorticotropin-Corticotropin Releasing Hormone (ACTH-CRH) Secretion. J. Clin. Endocrinol. Metab. 83: 305-308 [Full Text]  
• Fernandez, C. J., Haugwitz, M., Eaton, B., Moore, H.-P. H. (1997). Distinct Molecular Events during Secretory Granule Biogenesis Revealed by Sensitivities to Brefeldin A. Mol. Biol. Cell 8: 2171-2185 [Abstract] [Full Text]  
• Turpeinen, U., Markkanen, H., Valimaki, M., Stenman, U.-H. (1997). Determination of urinary free cortisol by HPLC. Clin. Chem. 43: 1386-1391 [Abstract] [Full Text]  
• Aron, D. C., Raff, H., Findling, J. W. (1997). Effectiveness Versus Efficacy: The Limited Value in Clinical Practice of High Dose Dexamethasone Suppression Testing in the Differential Diagnosis of Adrenocorticotropin-Dependent Cushing's Syndrome. J. Clin. Endocrinol. Metab. 82: 1780-1785 [Abstract] [Full Text]  
• Dahia, P. L. M., Honegger, J., Reincke, M., Jacobs, R. A., Mirtella, A., Fahlbusch, R., Besser, G. M., Chew, S. L., Grossman, A. B. (1997). Expression of Glucocorticoid Receptor Gene Isoforms in Corticotropin-Secreting Tumors. J. Clin. Endocrinol. Metab. 82: 1088-1093 [Abstract] [Full Text]  
• Estrada, J., Boronat, M., Mielgo, M., Magallon, R., Millan, I., Diez, S., Lucas, T., Barcelo, B. (1997). The Long-Term Outcome of Pituitary Irradiation after Unsuccessful Transsphenoidal Surgery in Cushing's Disease. NEJM 336: 172-177 [Abstract] [Full Text]