MEDICAL PROGRESS - CUSHINGS-SYNDROME

Harvey W. Cushing's 1932 description1of 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)2is 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,3is the most potent regulator of corticotropin secretion. Arginine vasopressin and other hypothalamic agents also stimulate corticotropin secretion.4,5Corticotropin is synthesized as a large precursor, pro-opiomelanocortin (POMC), which. . . © 1995, Massachusetts Medical Society. All rights reserved.