Pseudo-Cushing's syndrome

Infobox_Disease
Name = Pseudo-Cushing's syndrome


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ICD10 = ICD10|E|24|3|e|20
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eMedicineSubj = med
eMedicineTopic = 1936
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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 [cite journal | author=Newell-Price J, Trainer P, Besser M, Grossman A. | title=The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states. | journal=Endocr Rev | volume=19 | issue=5 | pages=647–72 | year=1998 | pmid=9793762 | doi=10.1210/er.19.5.647]

Prognosis

*Blood results and symptoms normalise rapidly on cessation of drinking or remission of depression

References