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Endogenous Cushing syndrome (CS) is caused by excess adrenal glucocorticoid secretion that is adrenocorticotropin(ACTH)-dependent or independent; ACTH-independent adrenocortical causes of CS account forup to 20% of CS in adults, and 15% in children over age 7 years. In younger children, ACTH-independent CSmay account for as many as half of the CS cases. In both adults and children, adrenocortical lesions causingCS include the common, isolated and sporadic, solitary cortisol-producing adenoma, the rare adrenocorticalcancer, and a spectrum of recently recognized, bilateral hyperplasias (bilateral adrenocortical hyperplasias,BAHs): micronodular adrenal disease and its pigmented variant, primary pigmented nodular adrenocorticaldisease are mostly genetic processes. Macronodular BAHs, ACTH-independent macronodular hyperplasia ormassive macronodular adrenocortical disease are less frequently genetic and almost never present in children(except in McCune-Albright syndrome); they present often with atypical CS in middle-aged or elderlyadults. The majority of benign adrenocortical tumors associated with CS are associated with defects of thecAMP signaling pathway, whereas adrenal cancer is linked to aberrant expression of growth factors andgermline or somatic mutations of tumor suppressor genes such as TP53. Adrenalectomy is the preferredmode of treatment for all adrenocortical causes of CS.

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Subject: Disorders of the Human Adrenal Cortex > 117 - 132: Cushing Syndrome Caused by Adrenocortical Tumors and Hyperplasias (Corticotropin- Independent Cushing Syndrome)

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