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Springer Cushing’s Syndrome (Monographs on Endocrinology Book 22) 1st Editon 2012 Softbound by D. T. Krieger
The unraveling of our knowledge of the functions of the adrenal gland constitutes one exciting development of modern medicine and biochemistry. We owe these advances to the felicitous cooperative efforts of the clinical investigator and the biochemist. Three centuries elapsed between the first recorded anatomical descrip tion of the adrenals and the demonstration by Dr. Addison in the mid-nineteenth century of the fatal results of the destruction of these glands by disease. It became evident from this observation that the adrenals secreted a 'factor' or 'factors' essential to life. It took approximately 90 years to isolate this elusive vital factor - cortisone - from beef adrenal cortices, independently by both Reichstein and his co-workers in Basle and Kendall and his group in the United States and another 10-15 years before it became more generally available for experimental and clinical use. It is perhaps difficult to believe that as recently as 35-40 years ago, before cortisone and cortisol were clinically available, the surgical removal of a benign adrenal cortical tumor in patients with Cushing's syndrome was associated with a prohibitive postoperative mortality rate. Within 12-36 h after operation, most of such patients developed an intractable state of shock, which was not manifested by significant electrolyte abnormalities or hypoglycemia and was unresponsive to the usual treatment for shock plus the generous use of salt-retaining hormone. 1. Brief Introduction to Cushing’s Syndrome and Disease.- References.- 2. Physiology of Regulation of ACTH Secretion.- A. Chemistry of ACTH.- B. Histology.- C. Physiology of ACTH Secretion.- References.- 3. ACTH Action.- A. Structure-Function Relationships.- B. Effect on Adrenal Size, Morphology, and Growth.- C. Mechanism of ACTH Action of Steroidogenesis.- D. Effect of ACTH on Aldosterone Secretion.- E. Dynamics of ACTH Secretion.- F. Extra-adrenal Metabolic Actions of ACTH.- G. Behavioral Effects of ACTH.- References.- 4. Actions of Adrenocortical Hormones.- A. Pathways of Corticosteroid Biosynthesis.- B. Mechanism of Glucocorticoid Action.- References.- 5. The Nature of ACTH-Related Peptides in Cushing’s Disease and Syndrome.- References.- 6. Clinical Manifestations of Cushing’s Disease and Cushing’s Syndrome.- A. Cushing’s Disease.- B. Adrenal Tumors.- C. “Primary” Pituitary Tumor.- D. Ectopic ACTH Production.- E. Differential Diagnosis of Cushing’s Disease and Syndrome.- References.- 7. Laboratory Diagnosis of Cushing’s Disease and Syndrome.- A. Measurement of Basal Corticosteroid Production.- B. Plasma ACTH Concentrations.- C. ACTH-Related Peptides: Lipotropin, Endorphin, and MSH.- D. Tests Involving Pituitary-Adrenal Stimulation and Suppression.- E. Response to Hypothalamic-Releasing Hormones.- F. Usefulness of Hormonal Tests in Differential Diagnosis.- G. Venous Catheterization for Ectopic ACTH-Producing Tumor Localization.- H. Pituitary X-Ray Localization.- J. Adrenal Localization.- References.- 8. Treatment of Cushing’s Disease and Syndrome.- A. Adrenal Adenoma.- B. Adrenocortical Carcinoma.- C. Ectopic ACTH-Producing Tumors.- D. Cushing’s Disease.- References.