Pseudo-Cushing's syndrome

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Pseudo-Cushing's syndrome Classification and external resources
ICD-10	E 24.3
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. 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.

1 Investigations
2 Differential diagnosis
3 Prognosis
4 References

[edit] Investigations

Levels of cortisol and ACTH are both high
24-hour urinary cortisol levels are high
Dexamethasone suppression test fails to suppress serum cortisol
Loss of diurnal variation in cortisol levels- Loss of Diurnal Variation is seen only in true Cushing's Syndrome or Disease.
High mean corpuscular volume and gamma-glutamyl transferase may be clues to alcoholism
Polycystic Ovarian Syndrome should be ruled out, since PCOS has similar symptoms.

[edit] Differential diagnosis

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]

[edit] Prognosis

Blood results and symptoms normalise rapidly on cessation of drinking or remission of depression

[edit] 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. doi:10.1210/er.19.5.647. PMID 9793762.

v • d • e Endocrine pathology: endocrine diseases (E00-35, 240-259)

Thyroid	Hypothyroidism (Iodine deficiency, Cretinism, Congenital hypothyroidism, Goitre, Myxedema) - Hyperthyroidism (Graves disease, Toxic multinodular goitre, Teratoma with thyroid tissue or Struma ovarii) - Thyroiditis (De Quervain's thyroiditis, Hashimoto's thyroiditis, Riedel's thyroiditis) - Euthyroid sick syndrome

Pancreas	Diabetes mellitus (type 1, type 2, coma, angiopathy, ketoacidosis, nephropathy, neuropathy, retinopathy, MODY) - Hypoglycemia - Hyperinsulinism - Zollinger-Ellison syndrome - insulin receptor (Rabson-Mendenhall syndrome)

Parathyroid	Hypoparathyroidism (Pseudohypoparathyroidism) - Hyperparathyroidism (Primary, Secondary, Tertiary)

Pituitary	Hyperpituitarism (Acromegaly, Hyperprolactinaemia, SIADH) - Hypopituitarism (Simmonds' disease/Sheehan's syndrome, Kallmann syndrome, Growth hormone deficiency, Diabetes insipidus) - Adiposogenital dystrophy - Empty sella syndrome - Pituitary apoplexy

Adrenal	Cushing's syndrome (Nelson's syndrome, Pseudo-Cushing's syndrome) - CAH (Lipoid, 3β, 11β, 17α, 21α) - Hyperaldosteronism (Conn syndrome, Bartter syndrome) - Adrenal insufficiency (Addison's disease) - Hypoaldosteronism

Gonads	ovarian dysfunction (Polycystic ovary syndrome, Premature ovarian failure) - testicular dysfunction (5-alpha-reductase deficiency) - testosterone biosynthesis (17-beta-hydroxysteroid dehydrogenase deficiency) - general (Hypogonadism, Delayed puberty, Precocious puberty)

Other	Androgen insensitivity syndrome - Autoimmune polyendocrine syndrome - Carcinoid syndrome - Gigantism - Short stature (Laron syndrome, Psychogenic dwarfism) - Multiple endocrine neoplasia (1, 2) - Progeria - Woodhouse-Sakati syndrome