Fifty patients bilaterally adrenalectomized for Cushing's disease were followed for 1 to 22 (mean, 12) years. In 14 of them (28%) Nelson's syndrome appeared within 1.5 to 12 (mean, 4.8) years after adrenalectomy. All the patients were deeply pigmented, 12 had a radiologically demonstrable tumour and six had visual defects. Plasma ACTH levels ranged from 450 to 8000 ng/l. However in every case at least one estimation during circadian studies equalled 2000 ng/l. One patient with an anaplastic pituitary tumour died 3 years after the discovery of the tumour. Anaplasia was also diagnosed in another patient with recurrence of pituitary tumour after a transsphenoidal operation. Symptoms of tumour infarction occurred in two patients, followed by clinical remission of Nelson's syndrome. In the majority of cases the course was benign. We conclude that all cases, however, should be followed indefinitely because Nelson's tumours are not infrequently aggressive.

Summary A young woman with Cushing's syndrome who had had amenorrhoea for six years was treated with cyproheptadine and became pregnant five months later. Treatment with cyproheptadine was continued till six weeks after delivery by which time all the features of Cushing's syndrome had disappeared. The baby developed normally but died of gastroenteritis when four months old. Two years later the patient became pregnant again without further treatment. Pregnancy and labour were uncomplicated and mother and son did well. A full remission of Cushing's syndrome was confirmed two months after delivery.

Unusually comprehensive studies of pulmonary function in hypertensive patients during left ventricular failure and cardiac asthma are presented. These findings are compared to those in mitral stenosis with congestive failure and in pulmonary emphysema with right heart failure. All patients were severely dyspneic and bedridden.

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