Cushing's Syndrome by Lewis S. Blevins

Cushing's Syndrome is a welcome addition to the literature on a subject that remains among the most difficult and challenging in endocrinology. It is because of these challenges that almost every year the Endocrine Society's annual meeting includes one or two sessions dedicated to Cushing's syndrome, adrenal tumors, or corticotropin-producing pituitary adenomas (Cushing's disease). A comprehensive as well as critical review of what is new in the field is therefore quite timely. This book is a reasonably up-to-date and well-presented review of the clinical presentation, diagnosis, and treatment of Cushing's syndrome and was written by some of the leading experts in the field. It comes from Vanderbilt University Medical Center, which for years was the only academic center on this side of the Atlantic where endocrine research dedicated almost exclusively to the study of the hypothalamic-pituitary-adrenal axis was undertaken. Virtually everything we know today about the diagnostic investigation and treatment of Cushing's syndrome is based directly on or is derived from knowledge that was generated in Nashville "by one of two giants in the field, either Dr. Grant Liddle or Dr. David Orth." In addition, some of today's leaders in basic and clinical research on Cushing's syndrome were trained at Vanderbilt and are contributors to this book. The book starts with a review of the physiology of the hypothalamic-pituitary-adrenal axis. Such a review is a necessary component of any book that covers diagnostic tests for Cushing's syndrome. However, this chapter fails to present a complete story; furthermore, it overlaps considerably with a chapter on corticotropin-producing adenomas. More comprehensive coverage of the actions of glucocorticoids would have been welcome. The chapter on clinical manifestations would have benefited from the inclusion of more pictures and references to more recent literature on vascular and orthopedic manifestations and atypical Cushing's syndrome. There is an excellent review of the psychiatric manifestations of Cushing's syndrome, which are an often overlooked component of this disorder. The chapters on diagnostic evaluation and on assay methods, by Newell-Price and Besser and by Nicholson and Workman, respectively -- leaders in the field -- are outstanding. Since the mid-1980s, there has not been a comprehensive evaluation of the use of steroid hormone assays in the diagnosis of Cushing's syndrome. I know I will frequently refer to these chapters from now on. The chapters that follow this one, on ectopic and adrenocortical Cushing's syndrome and on surgical and other treatments, are comprehensive reviews of their subjects, although admittedly some experts in the field would not agree with everything that is said in them. As in any multiauthored book, there are variations in style as well as in opinion (e.g., with regard to the proper cortisol level at midnight). But the book also represents the first major attempt since the early 1980s to gather under one cover the various aspects of this fascinating disorder. The ultimate judge of any book is its audience; the audience for this book is not experts in the field but rather fellows-in-training, general practitioners, and endocrinologists in practice. I recommend it to them wholeheartedly. I also would suggest this book to patients with Cushing's syndrome as well as to academic physicians who are interested in the clinical and molecular investigation of this disorder, both as a first step and as a guide to the intricacies and controversies surrounding the diagnosis and treatment of endogenous hypercortisolemia in humans. Constantine A. Stratakis, M.D., Ph.D.
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Owner Reviews, Ratings, Comments and Criticism
Cushing's Syndrome is a welcome addition to the literature on a subject that remains among the most difficult and challenging in endocrinology. It is because of these challenges that almost every year the Endocrine Society's annual meeting includes one or two sessions dedicated to Cushing's syndrome, adrenal tumors, or corticotropin-producing pituitary adenomas (Cushing's disease). A comprehensive as well as critical review of what is new in the field is therefore quite timely. This book is a reasonably up-to-date and well presented review of the clinical presentation, diagnosis, and treatment of Cushing's syndrome and was written by some of the leading experts in the field. It comes from Vanderbilt University Medical Center, which for years was the only academic center on this side of the Atlantic where endocrine research dedicated also exclusively to the study of the hypothalamic-pituitary-adrenal axis was undertaken. Virtually everything we know today about the diagnostic investigation and treatment of Cusing's syndrome is based directly on or is derived from knowledge that was generated in Nashville "by one of two giants in the field, either Dr. Grant Liddle or Dr. David Orth." In addition, some of today's leaders in basic and clinical research on Cushing's syndrome were trained at Vanderbilt and are contributors to this book. The book starts with a review of the physiology of the hypothalamic-pituitary-adrenal axis. Such a review is a necessary component of any book that covers diagnostic tests for Cushing's syndrome. However, this chapter fails to present a complete story; furthermore, it overlaps considerably with a chapter on corticotropin-producing adenomas. More comprehensive coverage of the actions of glucocorticoids would have been welcome. The chapter on clinical manifestations would have benefited from the inclusion of more pictures and references to more recent literature on vascular and orthopedic manifestations and atypical Cushing's syndrome. There is an excellent review of the psychiatric manifestations of Cushing's syndrome, which are an often overlooked compenent of this disorder. The chapters on diagnostic evaluation and on asay methods, by Newell-Price and Besser and by Nicholson and Workman, respectively - leaders in the field - are outstanding. Since the mid-1980s, there has not been a comprehensive evaluation of the use of steroid hormone essays in the diagnosis of Cushing's syndrome. I know I will frequently refer to these chapters from now on. The chapters that follow this one, on ectopic and adrenocortical Cushing's syndrome and on surgical and other treatments, are comprehensive reviews of their subjects, although admittedly some experts in the field would not agree with everything that is said in them. As in any multiauthored book, there are variations in style as well as in opinion (e.g., with regard to the proper cortisol level at midnight). But the book also represents the first major attempt since the early 1980s to gather under one cover the various aspects of this fascinating disorder. The ultimate judge of any book is its audience; the audience for this book is not experts in the field but rather fellows-in-training, general practioners, and endocrinologists in practice. I recommend it to them wholeheartedly. I also would suggest this book to patients with Cushing's syndrome as well as to academic physicians who are interested in the clinical and molecular investigation of this disorder, both as a first step and as a guide to the intricacies and controversies surrounding the diagnosis and treatment of endogenous hypercortisolemia in humans. Constantine A. Stratakis, M.D., Ph.D., National Institute of Child Health and Human Development, Bethesda, MD 20892-1862, N ENGL J MED 349:8 August 21, 2003