The adenoma causes cortisol levels in the blood to be very high, and negative feedback on the pituitary from the high cortisol levels causes ACTH levels to be very low.Cushings disease refers only to hypercortisolism secondary to excess production of ACTH from a corticotroph pituitary adenoma (secondary hypercortisolism/hypercorticism) or due to excess production of hypothalamus CRH (Corticotropin releasing hormone) (tertiary hypercortisolism/hypercorticism). This causes the blood ACTH levels to be elevated along with cortisol from the adrenal gland. The ACTH levels remain high because the tumor is unresponsive to negative feedback from high cortisol levels.When Cushings syndrome is due to extra ACTH it is known as ectopic Cushing syndrome. This may be seen in a paraneoplastic syndrome. When Cushings syndrome is suspected, either a dexamethasone suppression test (administration of dexamethasone and frequent determination of cortisol and ACTH level), or a 24-hour urinary measurement for cortisol offers equal detection rates. Dexamethasone is a glucocorticoid and simulates the effects of cortisol, including negative feedback on the pituitary gland. When dexamethasone is administered and a blood sample is tested, cortisol levels >50 nmol/L (1.81 μg/dL) would be indicative of Cushings syndrome because an ectopic source of cortisol or ACTH (such as adrenal adenoma) exists which is not inhibited by the dexamethasone. A novel approach, recently cleared by the US FDA, is sampling cortisol in saliva over 24 hours, which may be equally sensitive, as late-night levels of salivary cortisol are high in cushingoid patients. Other pituitary hormone levels may need to be ascertained.
A diagnosis of inappropriate sinus tachycardia is primarily one of exclusion, and the following may be observed:
Exclusion of all other causes of sinus tachycardia
Common forms of supraventricular tachycardia (SVT) must be excluded
Normal P wave morphology
A resting sinus tachycardia is usually (but not always) present
Nocturnal dip in heart rate
Inappropriate heart rate response on exertion
Mean heart rate in 24hrs >95 bpm
Symptoms are documented to be due to tachycardia
Hypotension is occasionally observed
Syncope (fainting) is occasionally reported

Treatment
IST has been treated both pharmacologically and invasively, with varying degrees of success. IST, in and of itself, is not indicative of higher rates of mortality, and non-treatment is an option chosen by many if they have minimal symptoms.Some types of medication tried by cardiologists and other physicians include: beta blockers, selective sinus node If channel inhibitors (such as ivabradine), calcium channel blockers, and antiarrhythmic agents. Some SSRI drugs are also occasionally tried, as are treatments more commonly used to treat postural orthostatic tachycardia syndrome, such as fludrocortisone.Invasive treatments include forms of catheter ablation such as sinus node modification (selective ablation of the sinus node), complete sinus node ablation (with associated implantation of a permanent artificial pacemaker), and AV node ablation in very resistant cases (creation of iatrogenic complete heart block, necessitating implantation of a permanent artificial pacemaker). However, invasive treatments can also make the symptoms worse. See also
Supraventricular tachycardia
Sinus tachycardia
Postural orthostatic tachycardia syndrome
Dysautonomia

References
Further reading
Yusuf, Shamil; Camm, A. John (2005). "Deciphering the sinus tachycardias". Clinical Cardiology. 28 (6): 267–76. doi:10.1002/clc.4960280603. PMC 6654702. PMID 16028460. Still, A; Raatikainen, P;  et al. (2005).