Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]}; Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]
Overview
Pseudo-Cushing’s syndrome must be differentiated from other diseases that cause hypertension, obesity, and hyperandrogenism, such as Metabolic syndrome X and Cushing’s syndrome. Depression may also cause similar symptoms.
Differentiating Pseudo Cushing’s Syndrome from other Diseases
- 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]
- Diseases with similar symptoms
-
The table below summarizes the findings that differentiate pseudo-Cushing’s disease from other conditions that may cause hypertension, hyperandrogenism, and obesity. Facial plethora, skin changes, osteoporosis, nephrolithiasis and neuropsychiatric conditions.[2][3][4][5]
| Conditions
|
Causes
|
Associated features
|
Diagnostic approach
|
| Pseudo-Cushing’s syndrome
|
- Obesity
- Alcoholism
- Depression
- HIV
|
|
- Urinary free cortisol
- Midnight salivary cortisol
- Low dose dexamethasone challenge test
- Glucose tolerance test
- Loperamide test
|
| Cushing’s syndrome
|
- Iatrogenic
- Pituitary adenoma
- Adrenal tumor
- Adrenal hyperplasia
- Ectopic ACTH secretion
|
|
- 24-hour urine cortisol
- Midnight salivary cortisol
- Low dose dexamethasone challenge test
- CRH stimulation
- High dose dexamethasone test
- MRI brain
- CT/MRI adrenals
|
| Metabolic syndrome X
|
- Familial/genetic
- Obesity
- Insulin resistance
|
|
|
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.
- ↑ Boscaro M, Barzon L, Fallo F, Sonino N (2001). “Cushing’s syndrome”. Lancet. 357 (9258): 783–91. doi:10.1016/S0140-6736(00)04172-6. PMID 11253984.
- ↑ Findling JW, Raff H (2001). “Diagnosis and differential diagnosis of Cushing’s syndrome”. Endocrinol. Metab. Clin. North Am. 30 (3): 729–47. PMID 11571938.
- ↑ 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/edrv.19.5.0346. PMID 9793762.
- ↑ “How Is Metabolic Syndrome Diagnosed? – NHLBI, NIH”.
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