COLLEGE OF MEDICAL AND DENTAL SCIENCES – ARTHUR THOMSON VISITING PROFESSOR LECTURE 2012
PROFESSOR WILLIAM F YOUNG Jr., MD, MSc, Chair, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
In his 1912 monograph (“The Pituitary Body and its Disorders”), Harvey Cushing described 50 cases, one of which concerned a young woman, Miss M.G. (now referred to as “Minnie G.”). Struck by the unusual features of M.G. and another case (E.G.F.), Cushing searched the literature and found 10 similar cases—these 12 cases then served as the basis for his subsequent report in 1932 (“The Basophil Adenomas of the Pituitary Body and Their Clinical Manifestations”). In 1912, Cushing wrote: “ . . . Miss M.G., a Russian Jewess, single, aged 23, was referred to us by Dr. De Witt Stetten of New York” . . . (to Cushing at Johns Hopkins Hospital in Baltimore). “A syndrome of painful obesity, hypertrichosis, and amenorrhoea, with over-development of secondary sexual characteristics accompanying a low grade of hydrocephalus and increased cerebral tension. Pituitary, adrenal, pineal, or ovary? Subtemporal exploration and decompression.” Cushing continued: “It will thus be seen that we may perchance be on the way toward the recognition of the consequences of hyperadrenalism of the ductless glands. Heretofore the only recognizable clinical state associated with primary adrenal disease has been the syndrome of Addison, and the grouping of these cases may possibly add one more to the series of clinical conditions related to primary maladies of the ductless glands.” In his 1932 monograph, Cushing correctly identified the cause of Cushing disease as a pituitary corticotroph adenoma—this was based on autopsy studies in 11 cases. However, he never performed or suggested pituitary surgery as a treatment. His only surgery on a patient with Cushing syndrome was Minnie G. and that was a subtemporal decompression (not pituitary-directed surgery) to relieve apparent increased intracranial pressure.
The highlights of this presentation include:
Minnie G.—the “rest of the story”
The early understanding of Cushing syndrome
Landmarks in diagnosis, localisation, and treatment
Where we are today
This lecture is open to all, pre-registration is not required.