The History of Cushing's Disease: A Controversial Tale

The history of Cushing's disease now goes back quite a long time. Yet no clear cut definition of the issues involved has emerged. The pathogenesis of the condition is still controversial. Harvey Cushing (1869-1939) was one of the most outstanding surgeons of the present century and, as Garrison put it, 'facile princeps in neurological surgery, particularly surgery of the head and the pituitary body' (Figure 1). Born in Cleveland, Ohio, and educated at Yale and Harvard Medical Schools, he worked, after spending some time in Europe, mainly at Johns Hopkins in Baltimore and, finally, as Moseley Professor of Surgery at the Harvard School of Medicine in Boston and Surgeon-in-Chief of the Peter Brent Brigham Hospital from 1912 to 1932. He gave his celebrated 'Oration in Surgery' on 'The Hypophysis Cerebri: Clinical Aspects of Hyperpituitarism and of Hypopituitarism' to the Section of Surgery of the American Medical Association at the 16th Annual Session, held at Atlantic City, in June 19091• At that time he still worked in Baltimore. The subject here concerns, however, his publication in 1932 of a polyglandular syndrome: 'The basophilic adenomas of the pituitary body and their clinical manifestations (pituitary basophilismj'P. This was a review of 12 such patients, the first of whom was a certain Minnie of New York. She developed the syndrome at the age of 16. Cushing had mentioned her briefly in 19123 and thought that her clinical picture resembled those seen in some adrenal tumours. Later he changed his opinion and said, if acromegaly was due to acidophil hyperpituitarism,