Pseudo-Cushing's syndrome
| Pseudo-Cushing's syndrome | |
|---|---|
| Classification and external resources | |
| Specialty | endocrinology |
| ICD-10 | E24.3 |
| eMedicine | med/1936 |
Pseudo-Cushing's syndrome is a medical condition in which patients display the signs, symptoms, and abnormal hormone levels seen in Cushing's syndrome. However, pseudo-Cushing's syndrome is not caused by a problem with the hypothalamic-pituitary-adrenal axis as Cushing's is; it is mainly an idiopathic condition, however a cushingoid appearance is sometimes linked to excessive alcohol consumption.[1]
Investigations
- Levels of cortisol and ACTH both elevated
- 24-hour urinary cortisol levels elevated
- Dexamethasone suppression test[2]
- Loss of diurnal variation in cortisol levels (seen only in true Cushing's Syndrome)
- High mean corpuscular volume and gamma-glutamyl transferase may be clues to alcoholism
- Polycystic Ovarian Syndrome should be ruled out; PCOS may have similar symptoms
Differential diagnosis
- Differentiation from Cushing's is difficult, but several tools exist to aid in the diagnosis[3]
- Alternative causes of Cushing's should be excluded with imaging of lungs, adrenal glands, and pituitary gland; these often appear normal in Cushing's
- In the alcoholic patient with pseudo-Cushing's, admission to hospital (and avoidance of alcohol) will result in normal midnight cortisol levels within five days, excluding Cushing's[4]
- Another cause for Cushing's syndrome is the extremely rare form of cancer (Adrenal Cortisol Carcinoma), when a benign lesion on the adrenal gland (which would cause Cushing's) becomes malignant and starts producing its own cortisol. This produces Cushing's-like symptoms and is fatal. Life expectancy depends on early detection. Ruling out ACC is done with a CT scan of the abdomen, identifying the size and location of adrenal tumors and lesions.[5]
Prognosis
- Blood results and symptoms normalise rapidly on cessation of drinking or remission of depression.
References
- ↑ Parveen June Kumar; Michael L. Clark (2005). Kumar and Clark clinical medicine. Elsevier Saunders. pp. 974–975. ISBN 978-0-7020-2763-5.
- ↑ Gatta B, Chabre O, Cortet C, et al. (November 2007). "Reevaluation of the combined dexamethasone suppression-corticotropin-releasing hormone test for differentiation of mild cushing's disease from pseudo-Cushing's syndrome". J. Clin. Endocrinol. Metab. 92 (11): 4290–3. doi:10.1210/jc.2006-2829. PMID 17635947.
- ↑ Gross BA, Mindea SA, Pick AJ, Chandler JP, Batjer HH (2007). "Diagnostic approach to Cushing disease". Neurosurg Focus. 23 (3): E1. doi:10.3171/foc.2007.23.3.2. PMID 17961030.
- ↑ 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. doi:10.1210/er.19.5.647. PMID 9793762.
- ↑ University of Michigan Adrenal Cancer Research Page
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