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[Cushing syndrome: Physiopathology, etiology and principles of therapy].
[cushing syndrome]
The
most
frequent
cause
of
Cushing
's
syndrome
is
iatrogenic
,
as
Cushing
's
syndrome
is
the
unavoidable
consequence
of
long
-term
glucocorticoid
treatment
using
more
than
7
.
5
mg
prednisone
per
day
.
The
most
frequent
cause
of
endogenous
Cushing
's
syndrome
is
Cushing
's
disease
(
CD
)
,
which
is
an
ACTH
dependent
hypercortisolism
linked
to
a
pituitary
corticotroph
adenoma
.
This
adenoma
is
often
very
small
,
its
diagnosis
may
require
bilateral
inferior
petrosal
sinus
sampling
and
the
first
line
treatment
of
CD
is
transsphenoidal
surgery
by
an
expert
neurosurgeon
.
The
second
line
treatments
include
drugs
that
can
act
either
on
the
pituitary
adenoma
or
on
adrenal
steroidogenesis
,
pituitary
radiotherapy
or
bilateral
adrenalectomy
.
Ectopic
ACTH
dependent
Cushing
's
syndrome
is
linked
either
to
poorly
differentiated
endocrine
tumors
with
a
very
poor
prognosis
,
such
as
small
cell
lung
cancer
,
or
to
well
differentiated
endocrine
tumors
,
such
as
bronchial
carcinoid
tumors
,
which
have
a
good
prognosis
when
treated
by
surgery
,
but
may
be
very
difficult
to
localize
.
Adrenal
Cushing
's
syndromes
,
which
are
independent
of
pituitary
ACTH
secretion
,
include
adrenal
cortex
carcinoma
,
which
requires
abdominal
surgery
with
extended
adrenalectomy
by
an
expert
surgeon
,
adrenal
adenoma
which
is
treated
by
laparoscopic
unilateral
adrenalectomy
and
bilateral
macronodular
hyperplasia
,
whose
surgical
treatment
may
require
unilateral
or
bilateral
adrenalectomy
.
Treatment
of
Cushing
's
syndrome
generally
leads
to
spectacular
clinical
results
,
which
must
not
hide
the
fact
that
the
reversibility
of
some
signs
is
actually
incomplete
.
This
underlines
the
need
for
a
timely
multidisciplinary
management
of
the
patients
by
an
expert
team
.
Diseases
Validation
Diseases presenting
"which must not hide the fact that the reversibility of some signs is actually incomplete"
symptom
cushing syndrome
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