ACTH-dependent Cushing's syndrome

Cushing's syndrome (CS) is a rare disease with possible devastating clinical consequences if not appropriately treated. Workup of CS can be challenging. It requires high clinical suspicion and several confirmatory laboratory tests and imaging procedures, detailed in this review. If a source is localized, then surgery should be pursued in those who are appropriate candidates. Early diagnosis and treatment are keys in preventing morbidity and mortality in patients with CS. The most prevalent comorbidity, hypertension, is the focus of this review on CS. The cause of hypertension in CS is complex and not well understood; the proposed mechanisms are discussed. There are many approaches to controlling hypertension in these patients though definitive treatment of CS is most effective. Medical therapy is used in those who are nonsurgical candidates or who have failed surgical therapy. Medications for CS may improve or worsen blood pressure necessitating use of additional agents for hypertension control.