The syndrome of adrenal cortical overactivity resulting from corticotrophin producing malignant tumours is reviewed. The primary neoplasm is most commonly an oat-cell carcinoma of the bronchus. The patient's appearance does not resemble that seen in Cushing's syndrome. Common symptoms include muscle weakness, oedema, mental disturbance, and skin pigmentation. The diagnosis is often suggested by the presence of a hypokalaemic alkalosis believed to result from the very high level of cortisol production. Other types of tumour include atypical thymomas, mediastinal neoplasms, malignant bronchial carcinoids and islet-cell carcinoma of the pancreas. In these cases the progress of the disease is slower and the classical picture of Cushing's syndrome more often seen.Five cases are described. Three were due to oat-cell carcinomas of the bronchus, one to a mediastinal neoplasm of uncertain origin and one to a medullary carcinoma of the thyroid. One of these patients was treated by total adrenalectomy and two others by the long-term administration of metyrapone.A case of Cushing's syndrome associated with a benign bronchial carcinoid is also reported. This association has been described before, but there is in sufficient evidence to show whether there is any causal relationship between the two conditions.
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