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Pseudo-Cushing syndrome
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Pseudo-Cushing syndrome

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Contributors: Amirah Khan MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

Pseudo-Cushing syndrome is hypercortisolism secondary to an underlying illness, as opposed to the exogenous or ectopic cortisol exposure that causes Cushing syndrome. Patients with pseudo-Cushing syndrome present with the same symptoms as Cushing syndrome: lipodystrophy, moon facies, abdominal striae, bruising, hirsutism, lethargy, weight gain, abnormal menses, osteopenia or fracture, and proximal muscle weakness. However, the patient will not have a history of glucocorticoid use or the presence of a tumor that is ectopically secreting cortisol, adrenocorticotropic hormone (ACTH), or corticotropin-releasing hormone (CRH). Rather than this ectopic or exogenous hypercortisolism, pseudo-Cushing syndrome is caused by overactivation of the normal hypothalamic-pituitary-adrenal axis.

Common causes of pseudo-Cushing syndrome include pregnancy, alcohol use disorder, morbid obesity, polycystic ovarian syndrome, end-stage renal disease, severe major depressive disorder, and poorly controlled diabetes. Treatment of the underlying illness will resolve the pseudo-Cushing syndrome.

Codes

ICD10CM:
E27.0 – Other adrenocortical overactivity

SNOMEDCT:
237737000 – Pseudo-cushing's syndrome

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Cushing syndrome – Differentiated from pseudo-Cushing syndrome by two abnormal first-line tests, which include 24-hour urinary free cortisol (UFC) excretion, overnight 1 mg dexamethasone suppression test (DST), CRH after dexamethasone test, late-night salivary cortisol, and late-night serum cortisol.

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 09/06/2018
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Pseudo-Cushing syndrome
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Pseudo-Cushing syndrome : Buffalo hump, Emotional stress or trauma, Moon facies, Proximal muscle weakness, Hirsutism, Hypertension, Striae
Copyright © 2019 VisualDx®. All rights reserved.