Pseudo Cushing's syndrome differential diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Pseudo Cushing's syndrome}} | {{Pseudo Cushing's syndrome}} | ||
{{CMG}}} | {{CMG}}}; {{AE}} {{MMF}} | ||
==Overview== | ==Overview== | ||
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. | |||
==Differentiating Pseudo Cushing's Syndrome from other Diseases== | ==Differentiating Pseudo Cushing's Syndrome from other Diseases== | ||
*Differentiation from Cushing's is extremely difficult | *Differentiation from Cushing's is extremely difficult | ||
*Causes of Cushing's should be excluded with imaging of the [[lung]]s, [[adrenal gland]]s, and [[pituitary gland]] - but these often appear normal in Cushing's anyway | *Causes of Cushing's should be excluded with imaging of the [[lung]]s, [[adrenal gland]]s, 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<ref>{{cite journal | author=Newell-Price J, Trainer P, Besser M, Grossman A. | title=The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states. | journal=Endocr Rev | volume=19 | issue=5 | pages=647-72 | year=1998 | id=PMID 9793762}}</ref> | *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<ref>{{cite journal | author=Newell-Price J, Trainer P, Besser M, Grossman A. | title=The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states. | journal=Endocr Rev | volume=19 | issue=5 | pages=647-72 | year=1998 | id=PMID 9793762}}</ref> | ||
;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|hypertensio]]<nowiki/>n, [[hyperandrogenism]], and [[obesity]]. Facial plethora, skin changes, [[osteoporosis]], [[nephrolithiasis]] and neuropsychiatric conditions.<ref name="pmid11253984">{{cite journal |vauthors=Boscaro M, Barzon L, Fallo F, Sonino N |title=Cushing's syndrome |journal=Lancet |volume=357 |issue=9258 |pages=783–91 |year=2001 |pmid=11253984 |doi=10.1016/S0140-6736(00)04172-6 |url=}}</ref><ref name="pmid11571938">{{cite journal |vauthors=Findling JW, Raff H |title=Diagnosis and differential diagnosis of Cushing's syndrome |journal=Endocrinol. Metab. Clin. North Am. |volume=30 |issue=3 |pages=729–47 |year=2001 |pmid=11571938 |doi= |url=}}</ref><ref name="pmid9793762">{{cite journal |vauthors=Newell-Price J, Trainer P, Besser M, Grossman A |title=The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states |journal=Endocr. Rev. |volume=19 |issue=5 |pages=647–72 |year=1998 |pmid=9793762 |doi=10.1210/edrv.19.5.0346 |url=}}</ref><ref name="urlHow Is Metabolic Syndrome Diagnosed? - NHLBI, NIH">{{cite web |url=https://www.nhlbi.nih.gov/health/health-topics/topics/ms/diagnosis |title=How Is Metabolic Syndrome Diagnosed? - NHLBI, NIH |format= |work= |accessdate=}}</ref> | |||
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{| align="center" | |||
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{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | |||
! style="background:#4479BA; color: #FFFFFF;" | Conditions | |||
! style="background:#4479BA; color: #FFFFFF;" |Causes | |||
! style="background:#4479BA; color: #FFFFFF;" |Associated features | |||
! style="background:#4479BA; color: #FFFFFF;" |Diagnostic approach | |||
|- | |||
| align="center" style="background:#DCDCDC;" |[[Pseudo-Cushing's syndrome]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
*Obesity | |||
*Alcoholism | |||
*Depression | |||
*HIV | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Obesity]] | |||
*[[Hypertension]] | |||
*[[PCOS]]/[[hyperandrogenism]] | |||
*[[Oligomenorrhea]]/[[hypogonadism]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
*Urinary free cortisol | |||
*Midnight salivary cortisol | |||
*Low dose dexamethasone challenge test | |||
*[[Glucose tolerance test]] | |||
*Loperamide test | |||
|- | |||
| align="center" style="background:#DCDCDC;" |[[Cushing's syndrome]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
*Iatrogenic | |||
*Pituitary adenoma | |||
*Adrenal tumor | |||
*Adrenal hyperplasia | |||
*Ectopic ACTH secretion | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Obesity]] | |||
*[[Hypertension]] | |||
*[[PCOS]]/[[hyperandrogenism]] | |||
*[[Oligomenorrhea]]/[[hypogonadism]] | |||
*[[Osteoporosis]] | |||
*[[Myopathy]]/cutaneous wasting | |||
*Neuropsychiatric problems | |||
*[[Kidney stone|Kidney stones]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
*24-hour urine cortisol | |||
*Midnight salivary cortisol | |||
*Low dose dexamethasone challenge test | |||
*CRH stimulation | |||
*High dose dexamethasone test | |||
*MRI brain | |||
*CT/MRI adrenals | |||
|- | |||
| align="center" style="background:#DCDCDC;" |[[Metabolic syndrome X]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
*Familial/genetic | |||
*Obesity | |||
*Insulin resistance | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Obesity]] | |||
*[[Hypertension]] | |||
*[[PCOS]]/[[hyperandrogenism]] | |||
*[[Oligomenorrhea]]/[[hypogonadism]] | |||
*[[Dyslipidemia]] | |||
*[[Diabetes mellitus|Diabetes]]/[[Glucose intolerance]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
*Waist circumference | |||
*[[Lipoproteins|Low-density lipoproteins]] | |||
*[[Lipoproteins|High-density lipoproteins]] | |||
*[[Glucose tolerance test]] | |||
*[[Fasting blood sugar]] | |||
*[[HbA1c]] | |||
|} | |||
==References== | ==References== | ||
Latest revision as of 20:21, 7 August 2017
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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]
Overview
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.
Differentiating Pseudo Cushing's Syndrome from other Diseases
- 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
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]
References
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