Cushing's syndrome: problems in diagnosis.

Cushing's syndrome, an unusual group of disorders characterized by hypercortisolism, must be considered in the differential diagnosis of such common clinical problems as hirsutism, menstrual irregularity, hypertension, diabetes mellitus, and obesity. Its distinct forms--pituitary-dependent Cushing's syndrome (Cushing's disease), adrenal tumor and ectopic ACTH syndrome--must be identified correctly so that specific therapy can be administered. In the majority of cases, use of a relatively simple diagnostic sequence will provide accurate and rapid diagnosis.

Silent pituitary apoplexy: subclinical infarction of an adrenocorticotropin-producing pituitary adenoma.

A young woman developed intermittent headaches and progressive hyperpigmentation after bilateral adrenalectomy for Cushing's disease. Results of sellar polytomography were abnormal. Her plasma ACTH levels increased to 4750-7340 pg/ml and did not rise with insulin-induced hypoglycemia.

Physiologic features of the canine esophagus: effect of modified Heller's esophagomyotomy.

The effects of the modified Heller's esophagomyotomy on function of the lower esophageal sphincter in the dog were studied. In normal dogs, this surgical procedure produced a les competent lower esophageal sphincter that still maintained the ability to prevent esophageal reflux.

Pheochromocytoma of the broad ligament. Localization by computerized tomography and ultrasonography.

Computerized tomography (CT) and ultrasonography demonstrated a pheochromocytoma of the broad ligament of the uterus in a patient in whom arteriographic findings had been negative. We suggest that either or both of these techniques be used initially because, although they are not histologically specific, they are noninvasive and sensitive. An additional advantage of CT is its ability to evaluate sites of extra-adrenal pheochromocytomas above the diaphragm.