Pseudo-Cushing's syndrome

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]}

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.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]}; Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]

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.

• 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

• Cushing’s syndrome
• Depression

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]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]}

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

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