Supriya Ghosh (Editor)

Pseudo Cushing's syndrome

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Specialty
  
endocrinology

eMedicine
  
med/1936

ICD-10
  
E24.3

Pseudo-Cushing's syndrome is a medical condition in which patients display the signs, symptoms, and abnormal hormone levels seen in Cushing's syndrome. However, pseudo-Cushing's syndrome is not caused by a problem with the hypothalamic-pituitary-adrenal axis as Cushing's is; it is mainly an idiopathic condition, however a cushingoid appearance is sometimes linked to excessive alcohol consumption.

Contents

Investigations

  • Levels of cortisol and ACTH both elevated
  • 24-hour urinary cortisol levels elevated
  • Dexamethasone suppression test
  • Loss of diurnal variation in cortisol levels (seen only in true Cushing's Syndrome)
  • High mean corpuscular volume and gamma-glutamyl transferase may be clues to alcoholism
  • Polycystic Ovarian Syndrome should be ruled out; PCOS may have similar symptoms
  • Differential diagnosis

  • Differentiation from Cushing's is difficult, but several tools exist to aid in the diagnosis
  • Alternative causes of Cushing's should be excluded with imaging of lungs, adrenal glands, and pituitary gland; these often appear normal in Cushing's
  • In the alcoholic patient with pseudo-Cushing's, admission to hospital (and avoidance of alcohol) will result in normal midnight cortisol levels within five days, excluding Cushing's
  • Another cause for Cushing's syndrome is the extremely rare form of cancer (Adrenal Cortisol Carcinoma), when a benign lesion on the adrenal gland (which would cause Cushing's) becomes malignant and starts producing its own cortisol. This produces Cushing's-like symptoms and is fatal. Life expectancy depends on early detection. Ruling out ACC is done with a CT scan of the abdomen, identifying the size and location of adrenal tumors and lesions.
  • Prognosis

  • Blood results and symptoms normalise rapidly on cessation of drinking or remission of depression.
  • References

    Pseudo-Cushing's syndrome Wikipedia