Pseudo-Cushing's syndrome (patient information)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Jinhui Wu, M.D.

Overview

Pseudo-Cushing's syndrome is a rare endocrine disorder in which patients display the signs, symptoms, and abnormal hormone levels seen in Cushing's syndrome. However, it is not a disease caused by the problem of the hypothalamic-pituitary-adrenal axis, but an idiopathic condition. The mechanism of pseudo-Cushing's syndrome remains unclear. Studies demonstrate that it is associated with some conditions, such as alcoholism or alcohol withdrawal, severe stresses, and some psychiatric conditions. Signs and symptoms of pseudo-Cushing's syndrome are similar to true Cushing's syndrome, such as truncal obesity, plethoric moon face, buffalo hump, thin skin, hypertension, increased appetite, weight gain, mood swings and fatigue. Cortisol level in salivary, urinary and blood may help diagnose. There is no specific medications for this disorder. Prognosis of pseudo-Cushing's syndrome depends on the cause and the person.

How do I know if I have pseudo-Cushing's syndrome and what are the symptoms of pseudo-Cushing's syndrome?

Signs of patients with pseudo-Cushing's syndrome are similar to Cushing's syndrome. They include the following characteristics.

• Truncal obesity, plethoric moon face, buffalo hump
• Supraclavicular fat pads
• Hirsutism and menstrual irregularities in women
• Thin skin with easy bruising and wide, purplish striae
• Hypertension
• Increased appetite, weight gain
• Depression, or mood swings, anxiety
• Fatigue
• Trouble sleeping

Who is at risk for pseudo-Cushing's syndrome?

• Alcoholism or alcohol withdrawal
• Severe stresses
• Psychiatric conditions such as depression, panic disorders and psychotic conditions.

How to know you have pseudo-Cushing's syndrome?

• 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.

When to seek urgent medical care?

Call your health care provider if symptoms of pseudo-Cushing's syndrome develop. If you experience either of the following symptoms, seeking urgent medical care as soon as possible:

• Severe hypertension

Treatment options

Treatments of pseudo-Cushing's syndrome depend on the cause. There is no specific medications for this disorder.

• Anticipate and prevent alcohol withdrawal syndrome.
• Treat psychiatric conditions, relieve stresses.

Diseases with similar symptoms

• Cushing's syndrome
• Depression

Where to find medical care for pseudo-Cushing's syndrome?

Directions to Hospitals Treating pseudo-Cushing's syndrome

Prevention of pseudo-Cushing's syndrome

• Avoidance of alcohol abuse.
• Avoidance too much pressure. If needed, go to see your psychologist.

What to expect (Outook/Prognosis)?

Prognosis of pseudo-Cushing's syndrome varies, depending on the cause and the person. With abstinence from alcohol, all biochemical abnormalities return to reference ranges. But patients with chronic alcoholism often relapse.

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