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Adrenal tumors can be primary or secondary entities. Primary tumors are able to secrete hormones which may cause significant effects clinically. Typical tumor-related adrenal diseases are Conn's syndrome (hyperaldosteronism), Cushing's syndrome (hypercortisolism), and pheochromocytoma (catacholamine excess). Primary adrenal tumors are rarely malignant, but adrenocortical neoplasias show a relation between tumor size and rate of malignancy. Diagnostic methods for adrenal tumors include hormone tests and imaging. The first choice of treatment is surgical removal, today preferably by minimally invasive approaches.

We report functionally successful hepatic and left adrenal embolization with particles to treat Cushing's syndrome associated with a medullary thyroid carcinoma.

We present a patient with an ACTH producing neuroendocrine tumor of the hepatic bile duct which was detected by chance during abdominal surgery for Cushing's syndrome. Diagnostic strategy and surgical therapy in patients with neuroendocrine tumors are discussed. The diagnostic problems caused by combination with an endocrine function disorder like Cushing's syndrome are pointed out.

An analysis is presented of the immunohistological and ultrastructural features in a series of 118 surgically removed pituitary adenomas all of which were studied immunohistologically using antisera to growth hormone (GH), prolactin (PRL) ACTH, beta FSH, beta LH and beta TSH, and 75 of which were studied ultrastructurally. Results were analysed according to the mode of presentation of patients. Forty-one (35%) of the tumours were from patients with acromegaly or gigantism, ten (9%) from patients with Cushing's syndrome or Nelson's syndrome, 19 (16%) from patients with clinical features associated with hyperprolactinaemia and 48 (40%) from patients with space occupying lesions which appeared clinically to be overtly endocrinologically functionless. By light microscopy, using the immunoperoxidase (PAP) technique, immunoreactive GH was demonstrated in all the tumours from patients with acromegaly or gigantism, immunoreactive ACTH in all tumours from patients with Cushing's syndrome or Nelson's syndrome and immunoreactive PRL in 95% of tumours associated with effects of hyperprolactinaemia. Forty-five percent of the tumours from acromegalic patients contained some PRL-positive cells as well as GH-positive cells. Among the tumours which appeared clinically to be endocrinologically functionless were three tumours (from males) uniformly stained for immunoreactive PRL. Of the remainder, 60% were negative for immunoreactive hormones and 40% contained small numbers of cells which were positive for a variety of immunoreactive hormones. ACTH-cell and PRL-cell tumours had ultrastructural features as described in previous studies. Fifty percent of GH-cell tumours examined at the EM level contained fibrous bodies, while in the remainder these structures were not identified. Tumours with fibrous bodies were more likely to contain PRL as well as GH with immunoperoxidase. All tumours that were endocrinologically functionless and which were examined at the EM level contained secretory granules. Oncocytic change was common in these tumours. No ultrastructural differences were observed between those which contained immunoreactive hormones by light microscopy and those which did not.

Bilateral adrenalectomy was performed in a 27-year-old male because of Cushing's syndrome. After 7 years a peripheral bronchial carcinoid was diagnosed; ACTH values went back to normal only after removal of the carcinoid. In the literature, there are 31 case reports on bronchial carcinoids associated with Cushing's syndrome. The Cushing's syndrome precedes the diagnosis of a tumor for months to years in at least half of the cases. Most of these patients first underwent adrenalectomy and/or hypophysectomy for their primarily endocrine symptoms and signs.

A case of Cushing's syndrome in pregnancy due to adrenal adenoma is described. Despite the poor prognosis and the fact that treatment was delayed until after delivery, a normal term infant was born and maternal outcome was good.

Tissues from 12 human corticotropin-secreting adenomas, obtained during transsphenoidal surgery for Cushing's disease (CD, ten cases) or Nelson's syndrome (NS, two cases), were mechanically dispersed. The resulting single cells and cell aggregates were plated on extracellular matrix derived from bovine corneal endothelia. CD and NS cells showed distinct morphological differences initially, CD cells being much more spherical than the flattened NS cells. By 10 days at the latest after plating, however, CD and NS cells were indistinguishable morphologically. Cultured cells from both entities responded with rounding to cortisol (hydrocortisone, 10(-6) M) within 4-6 h. Synthetic ovine corticotropin-releasing factor (10(-8) M) produced flattening and extension of cytoplasmic processes after as early as 2 h.

The case of a 56-year old woman with severe Cushing's syndrome due to ovarian ACTH-production is described. Both clinical picture and biochemical pattern were consistent with the ectopic ACTH syndrome. ACTH was found by specific immunohistochemical staining in a carcinoid tumor of the patient's right ovary. In contrast, pituitary cells exhibited immunoreactive ACTH to only a minimum extent.