
the development of bilateral adenomatous adrenal hyperplasia
in a case of cushing's syndrome of eighteen years' duration.
a case of cushing's syndrome of 18 years'
duration is presented.  the disease
began when the patient was 8 years old and
was partially controlled by pituitary
radiation when she was 13.  however, clinical
evidence indicate low grade but continuous
adrenocortical activity for the next 13
years.  the probable suppression
of gh secretion by the increased steroid levels
during her growth period provides
a reasonable explanation for the dwarfism of
the patient.  the administration of 8 mg
of dexamethasone per day failed to decrease
urinary steroid excretion.  bilateral
nodular hyperplasia was found at surgery.
it is suggested from the evidence presented
that this patient's disease began first
as a primary pituitary process but
during the long duration of the acth secretion
it evolved into one of autonomously
functioning bilateral nodular hyperplasia.
