|Classification and external resources|
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.
- Levels of cortisol and ACTH both elevated
- 24-hour urinary cortisol levels elevated
- Dexamethasone suppression test
- 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
- Differentiation from Cushing's is difficult, but several tools exist to aid in the diagnosis
- 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
- Another cause for Cushing's syndrome is adrenocortical carcinoma (ACC). This is a rare form of cancer with an incidence of 1-2/1000000/year. Circa 60% of ACCs secrete hormones, with cortisol being the most frequent. Most patients present in an advanced disease state and the outcome is dismal.
- Blood results and symptoms normalise rapidly on cessation of drinking or remission of depression.
- 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.
- Allolio B, Fassnacht M (2006). "Adrenocortical Carcinoma: Clincal Update". J Clin Endocrinol Metab. 91 (6): 2027–2037. doi:10.1210/jc.2005-2639. PMID 16551738.