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Aetiology

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Most cases are iatrogenic, resulting from the therapeutic administration of supraphysiological doses of glucocorticosteroids or adrenocortiocotrophin.

Spontaneous Cushing's syndrome may be due to:

  • Cushing's disease - 66% of such causes
  • ectopic ACTH secretion - 11% - most frequently asssociated with small cell carcinoma of the bronchus; less often, carcinoid tumours of the lungs, thymus, pancreas, very rarely islet cell tumours and Wilms tumours
  • adrenal adenoma - 9% secrete cortisol
  • adrenal carcinoma - 7% secrete cortisol
  • pseudo Cushings - 5%, excess cortisol production in association with alcohol or severe depressive psychosis
  • macrondular adrenal hyperplasia - rare
  • ectopic secretion of corticotrophin releasing factor - CRH - rare

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