Pseudo-Cushing's syndrome
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| Pseudo-Cushing's syndrome | |
| ICD-10 | E24.3 |
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Pseudo Cushing's syndrome Microchapters |
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Differentiating Pseudo Cushing's syndrome from other Diseases |
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Diagnosis |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pseudo-Cushing's syndrome is a medical condition in which patients display the signs, symptoms, and abnormal hormone levels seen in Cushing's syndrome. Pseudo-Cushing's syndrome, however, is not caused by a problem with the hypothalamic-pituitary-adrenal axis as Cushing's is. It is an idiopathic condition.
Investigations
- Levels of cortisol and ACTH are both high
- 24-hour urinary cortisol levels are high
- 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.
Differential diagnosis
- Differentiation from Cushing's is extremely difficult
- Causes of Cushing's should be excluded with imaging of the lungs, adrenal glands, and pituitary gland - but these often appear normal in Cushing's anyway
- In the alcoholic patient with pseudo-Cushing's, admission to hospital (and avoidance of alcohol) will result in normal midnight cortisol levels within 5 days, excluding Cushing's[1]
Prognosis
- Blood results and symptoms normalise rapidly on cessation of drinking or remission of depression
References
- ↑ Newell-Price J, Trainer P, Besser M, Grossman A. (1998). "The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states". Endocr Rev. 19 (5): 647–72. PMID 9793762.