[Multiple recurrence of Cushing's syndrome after bilateral adrenalectomy and pituitary gland surgery. Cure with o,p'-DDD].

A pituitary-dependent Cushing's syndrome in a young woman had an unusually protracted course and was extremely resistant to therapy. After unsuccessful pituitary irradiation, bilateral total adrenalectomy was performed. A piece of an excised adrenal gland was reimplanted into a buttock. Nevertheless, the patient went into adrenocortical failure and had to be given replacement therapy. After three years the Cushing's syndrome reappeared, this time combined with general hyperpigmentation. The implanted adrenal tissue was no longer to be found. Neither stereotactic pituitary coagulation nor implantation of 90-Yttrium into the pituitary resulted in remission of Cushing's syndrome. All attempts to localize the--very probably ectopic--cortisol-producing adrenocortical tissue failed. However, complete remission was finally achieved by treatment with o,p'-DDD.