Administration of synthetic ACTH is also possible, but ACTH is less often prescribed due to cost and lesser utility. Rarely, Cushings syndrome can also be due to the use of medroxyprogesterone acetate. In exogenous Cushings, the adrenal glands may often gradually atrophy due to lack of stimulation by ACTH, the production of which is suppressed by glucocorticoid medication. Abruptly stopping the medication can thus result in acute and potentially life-threatening adrenal insufficiency and the dose must hence be slowly and carefully tapered off to allow internal cortisol production to pick up. In some cases, patients never recover sufficient levels of internal production and must continue taking glucocorticoids at physiological doses for life.Cushings syndrome in childhood is especially rare and usually results from use of glucocorticoid medication. Endogenous
Endogenous Cushings syndrome results from some derangement of the bodys own system of cortisol secretion. Normally, ACTH is released from the pituitary gland when necessary to stimulate the release of cortisol from the adrenal glands. In pituitary Cushings, a benign pituitary adenoma secretes ACTH. This is also known as Cushings disease and is responsible for 70% of endogenous Cushings syndrome. In adrenal Cushings, excess cortisol is produced by adrenal gland tumors, hyperplastic adrenal glands, or adrenal glands with nodular adrenal hyperplasia. Tumors outside the normal pituitary-adrenal system can produce ACTH (occasionally with CRH) that affects the adrenal glands. This etiology is called ectopic or paraneoplastic Cushings disease and is seen in diseases such as small cell lung cancer.
The philosopher Simone Weil wrote that feeding the hungry when you have resources to do so is the most obvious of all human obligations. She says that as far back as Ancient Egypt, many believed that people had to show they had helped the hungry in order to justify themselves in the afterlife. Weil writes that Social progress is commonly held to be first of all, "...a transition to a state of human society in which people will not suffer from hunger." Social historian Karl Polanyi wrote that before markets became the worlds dominant form of economic organization in the 19th century, most human societies would either starve all together or not at all, because communities would invariably share their food.While some of the principles for avoiding famines had been laid out in the first book of the Bible, they were not always understood. Historical hunger relief efforts were often largely left to religious organizations and individual kindness. Even up to early modern times, political leaders often reacted to famine with bewilderment and confusion. From the first age of globalization, which began in the 19th century, it became more common for the elite to consider problems like hunger in global terms. However, as early globalization largely coincided with the high peak of influence for classical liberalism, there was relatively little call for politicians to address world hunger.In the late nineteenth and early twentieth century, the view that politicians ought not to intervene against hunger was increasingly challenged by campaigning journalists.