Improving outcome in Cushing's syndrome.

Cushing's syndrome was first described by Harvey Cushing in 1912 at a time when the detection of ACTH as the cause of corticotroph adenomas was still decades ahead. He reported on a 22-year-old woman, Minnie G., who suffered 'from a 7-year history of painful adiposity, hypertrichosis and amenorrhea.' (1). The circumstances of the case description and the natural course have been reconstructed due to the detailed work of Carney (2) and Pendleton et al. (3). It took Harvey Cushing 20 more years to firmly verify the hypothesis that this syndrome is caused by basophile (corticotroph) adenomas of the pituitary (4). Progress in diagnosing and treating Cushing's syndrome has been slow following the first few decades after Cushing's seminal description. For years, it appeared to be an orphan disease with relatively few advances in diagnosis and treatment. This is mainly attributable to the rarity of Cushing's syndrome: an incidence of one to three new cases per million has been reported consistently from several countries (5). Therefore, many advances have been the result of medical spillovers from other more frequent but related pituitary or adrenal diseases, and it took 100 years to develop, approve and license the first drug specifically addressing Cushing's disease – pasireotide (6). Since 2008, the scientific number of articles addressing Cushing's syndrome is steadily increasing in PubMeding'sCsyndrome). This development reflects both the recent progress in diagnoses and treatment and the increased awareness that orphan diseases receive in our days. In 2014, we felt that the progress in Cushing-directed research has been so significant that a meeting dedicated only to Cushing's syndrome might be justified. The main goal of the meeting was achieved by summoning the world experts of Cushing's syndrome to reflect the current state-of-the-art diagnosis and treatment, discuss challenges and unsolved issues and develop collaborative projects by combining forces to develop more effective and targeted approaches. The conference Improving Outcome in Cushing's syndrome (IMPROCUSH) was held from the 12th to the 14th of October 2014 in the beautiful surroundings of the Carl Friedrich von Siemens Foundation in the vicinity of Nymphenburg Palace in Munich. Over 100 scientists from around the world attended the meeting and discussed a broad spectrum of topics ranging from pathophysiology to treatment. This special issue includes 13 invited articles summarizing main presentations given at the symposium. The topics covered in this issue are broad and can be divided into three categories. First, there …