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A new method was developed for therapy of Icenko-Cushing's disease using transcatheter transvenous destruction of the adrenals (TTDA) to replace commonly used adrenalectomy. TTDA was performed by means of venous extravasation of a radiopaque agent (76% verografin solution) and its deposition in the organ parenchyma. TTDA was performed in 57 patients with Icenko-Cushing's disease using 3 tactical approaches including roentgenovascular intervention: bilateral TTDA, unilateral TTDA combined with unilateral adrenalectomy and unilateral TTDA combined with chloditan. TTDA is an effective method of invasive suppression of function of the cortex of the endocrine glands. TTDA superiority over surgical methods of therapy Icenko-Cushing's disease is that an effect of adrenalectomy is achieved without a risk of surgical intervention and narcosis.

The results are presented of the combined drug treatment of 39 patients with Icenko-Cushing's disease, using steroidogenesis inhibitor chloditane (o.p-DDD) and corticotropin secretion blocker peritol (cyproheptadine). The control group of 40 patients, suffered from the above disease of the same severity, was treated with alone chloditane. In the control group the inhibition of the adrenocortical glucocorticoid activity by chloditane was accompanied by twofold increase in the blood plasma corticotropin level. The relapse was noted in 24 of 40 patients after 5 to 6 months. The inhibition of glucocorticoid activity did not induce corticotropin secretion activation in patients, treated with chloditane and peritol. At the delayed terms of the treatment course the basal level of plasmatic corticotropin continued to lower and averaged the subnormal values. Relapses of the disease were seen in only 8 of 39 patients. The combined chloditane-perikol treatment of Icenko-Cushing's disease is likely to be perspective.

Altogether 28 patients with adrenocortical tumors (corticosteromas and corticoandrosteromas) were examined using a radioimmunoassay to determine the concentration of corticotropin, cortisol, blood cyclic nucleotides, the circadian rhythm and time course of corticotropin and cortisol levels against a background of insulin hypoglycemia. In patients with Itsenko-Cushing's syndrome the basel level of cortisol was notably raised, that of corticotropin was sharply decreased. The circadian rhythm of the levels of corticotropin and cortisol was disturbed, a response of the hypophyseal-adrenal system to a stressor was suppressed. The concentration of blood cyclic nucleotides was increased, and these changes were dependent on the nature of adrenal pathology.

To inhibit corticotropic function of the pituitary and glucocorticoid function of the adrenal cortex in the treatment of 41 patients with Icenko-Cushing's disease, use was made of the steroidogenesis inhibitor chloditane and high doses of reserpine. The treatment data were compared to the effect of chloditane alone in 40 patients. Inclusion of reserpine into the complex of therapeutic measures led to an appreciable decrease in corticotropin secretion which increased again shortly after the drug discontinuation. The clinical results of the treatment were comparable to those attained with administration of chloditane alone. The majority of patients manifested recurrent disease 3 to 12 months after the treatment was discontinued. Therefore, administration of reserpine as an additional means in the treatment was discontinued. Therefore, administration of reserpine as an additional means in the treatment of Icenko-Cushing's disease by chloditane with a view of a steady inhibition of corticotropic function of the pituitary and the prophylaxis of recurrencies is not desirable. High doses of reserpine may be recommended at the initial stages of the disease treatment in the presence of an extremely high level of blood plasma corticotropin.