A clinico-pathological study of Cushing's syndrome at the University Hospital of the West Indies and a review of the literature

Cushing syndrome is an uncommon but important disease. Twenty-one confirmed cases of spontaneous Cushing syndrome were documented at the University Ho spital of the West Indies over a 21-year period. They were predominantly yo ung females (F.-M ratio of 17:4; mean age 25 years and 3 months). The commo nest presenting symptoms were amenorrhoea (41%) and obesity (19%). Common c linical features were cushingnoid features (95%), hypertension (76%) and hi rsutism (82%). Twenty-nine per cent had frank hyperglycaemia. Cushing syndr ome was due to Cushing disease in 10 cases, adrenal adenoma in 3 and adrena l carcinoma in 2 cases. In 4 cases with presumed adrenal hyperplasia, the h istology was either unavailable or was not consistent with the diagnosis. T wo cases appear now to have had the ectopic ACTH Syndrome. Adrenalectomy wa s the commonest treatment offered. There were no intra-operative or post-op erative deaths but recurrence was common after subtotal adrenalectomy in Cu shing disease. Twenty-seven per cent of the patients developed Nelson syndr ome, which was fatal in 50%. Long-term hormone replacement therapy was unne cessary after surgery for adrenal adenomas. Treatment of Cushing syndrome w as well tolerated by the patients.