Pseudo-Cushing's syndrome

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	Pseudo-Cushing's syndrome;
ICD-10	E24.3
eMedicine	med/1936

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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.

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[1] 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.

[1]

v t e Endocrine pathology: endocrine diseases (E00-35, 240-259)
Thyroid	Hypothyroidism (Iodine deficiency, Cretinism, Congenital hypothyroidism, Goitre, Myxedema) - Hyperthyroidism (Graves disease, Toxic multinodular goitre, Teratoma with thyroid tissue or Struma ovarii) - Thyroiditis (De Quervain's thyroiditis, Hashimoto's thyroiditis, Riedel's thyroiditis) - Euthyroid sick syndrome
Pancreas	Diabetes mellitus (type 1, type 2, coma, angiopathy, ketoacidosis, nephropathy, neuropathy, retinopathy) - Hypoglycemia - Hyperinsulinism - Zollinger-Ellison syndrome - insulin receptor (Rabson-Mendenhall syndrome)
Parathyroid	Hypoparathyroidism (Pseudohypoparathyroidism) - Hyperparathyroidism (Primary, Secondary, Tertiary)
Pituitary	Hyperpituitarism (Acromegaly, Hyperprolactinaemia, SIADH) - Hypopituitarism (Simmonds' disease / Sheehan's syndrome, Kallmann syndrome, Growth hormone deficiency, Diabetes insipidus) - Adiposogenital dystrophy - Empty sella syndrome - Hypophysitis
Adrenal	Cushing's syndrome (Nelson's syndrome, Pseudo-Cushing's syndrome) - CAH (Lipoid, 3β, 11β, 17α, 21α) - Hyperaldosteronism (Conn syndrome, Bartter syndrome) - Adrenal insufficiency (Addison's disease) - Hypoaldosteronism
Gonads	Ovarian dysfunction (Polycystic ovary syndrome, Premature ovarian failure) - Testicular dysfunction (5-alpha-reductase deficiency) - Testosterone biosynthesis (17-beta-hydroxysteroid dehydrogenase deficiency) - General (Hypogonadism, Delayed puberty, Precocious puberty)
Other	Androgen insensitivity syndrome - Autoimmune polyendocrine syndrome - Carcinoid syndrome - Gigantism - Short stature (Laron syndrome, Psychogenic dwarfism) - Multiple endocrine neoplasia (1, 2) - Progeria - Woodhouse-Sakati syndrome