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Special Clinical Scenarios

CYCLIC CUSHING'S SYNDROME

Most patients with Cushing's syndrome demonstrate consistently elevated glucocorticoid values. A small subset show significant variability in glucocorticoid secretion, alternating normal and elevated values on a regular or irregular basis.[384] The few cases of spontaneous remission of Cushing's syndrome, including Cushing's first patient, may fit into this category.[2,385,386] The clinical course of patients with this type of intermittent, cyclic, or periodic Cushing's syndrome may be invariant, usually with mild signs and cushingoid symptoms, or it may parallel the biochemical abnormalities, with exacerbation of cushingoid features that parallel increased glucocorticoid production. The etiologic distribution is altered; in a recent review, Cushing's disease, ectopic ACTH secretion, and primary adrenal causes accounted for 54%, 26%, and 11%, respectively, of 65 cases, with the remainder being unclassified.[387]

Patients with periodic …