Fully developed picture of Cushing's syndrome in a female patient with medullary carcinoma of the thyroid gland: some diagnostic difficulties in this paraneoplastic syndrome.

The authors present a further description of the classical picture of Cushing's syndrome in a female patient with medullary carcinoma of the thyroid gland (MCT). Analysis of data reported in the literature and the author's own experience indicate the necessity of radical treatment of MCT before the development of the clinical paraneoplastic syndrome and of efforts to detect it in the preclinical stage. Developed Cushing's syndrome or hypokalaemic alkalosis are in the great majority late symptoms associated as a rule with advanced dissemination of the tumour. Metastases in the liver are particularly frequent. As regards therapy, bilateral adrenalectomy is recommended when it is obvious that attempts to eradicate MCT are hopeless, even where the affection of the adrenals seems to be unilateral. Radical surgery of the tumour and of regional metastases, if there is no remote dissemination, is the optimal solution, which can be used, however, only in exceptional cases.