Pseudo-Cushing's syndrome
| Pseudo-Cushing's syndrome | |
|---|---|
| Specialty | Endocrinology |
Pseudo-Cushing's syndrome or non-neoplastic hypercortisolism is a medical condition in which patients display the
idiopathic condition, however a cushingoid appearance is sometimes linked to excessive alcohol consumption.[1] Elevated levels of total cortisol can also be due to estrogen found in oral contraceptive pills that contain a mixture of estrogen and progesterone. Estrogen can cause an increase of cortisol-binding globulin and thereby cause the total cortisol level to be elevated.[2]
Signs and symptoms
![[icon]](/File:Wiki_letter_w_cropped.svg){kind=small} | This section is empty. You can help by adding to it. (May 2022) |
Diagnosis
- Levels of ACTHboth elevated
- 24-hour urinary cortisol levels elevated
- Dexamethasone suppression test[3]
- Late night salivary cortisol (LNSC)[4]
- Loss of diurnal variation in cortisol levels (seen only in true Cushing's Syndrome)
- High gamma-glutamyl transferase may be clues to alcoholism
- Polycystic Ovarian Syndromeshould 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[5]
- 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[6]
- Another cause for Cushing's syndrome is adrenocortical carcinoma. This is a rare form of cancer with an incidence of 1-2 per million people annually. About 60% of these cancers produce hormones, with cortisol being the most frequent. Most patients present in an advanced disease state and the outcome is dismal.[7]
Prognosis
- Blood results and symptoms normalise rapidly on cessation of drinking or remission of depression.[citation needed]