Pseudo Cushing's syndrome laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]}

Laboratory Findings

• Dexamethasone suppression test fails to suppress serum cortisol
• Loss of diurnal variation in cortisol levels- Loss of Diurnal Variation is seen only in true Cushing's Syndrome or Disease.
• High mean corpuscular volume and gamma-glutamyl transferase may be clues to alcoholism
• Polycystic Ovarian Syndrome should be ruled out, since PCOS has similar symptoms.
• Salivary cortisol level: Measurement of ate-night salivary cortisol concentrations can be used as a screening test in suspected pseudo-Cushing's syndrome.
• The 24-hour urinary free cortisol (UFC): In this test, a patient’s urine is collected several times over a 24-hour period and tested for cortisol. Patients with pseudo-Cushing's syndrome may show moderately increased in the 24-hour urinary free cortisol (UFC) level.
• Blood level of cortisol: Patients with pseudo-Cushing's syndrome may show elevated levels of serum cortisol in the morning and evening and the morning level is not suppressed to less than 5 µg/dL by 1 mg dexamethasone administered at midnight. A midnight cortisol level of less than 7.5 µg/dL is an important difference between pseudo-Cushing and true Cushing's syndrome.
• Liver function: Elevation of serum transaminase levels suggest alcohol-induced hepatitis.
• Blood alcohol level: Because many patients of pseudo-Cushing's syndrome are caused by alcohol abuse, blood alcohol level may be helpful.