Pseudo-Cushing’s States

Pseudo-Cushing's syndrome (PCS) is a medical condition in which patients display the signs , symptoms , and abnormal hormone levels seen in Cushing's syndrome (CS). However, PCS is not caused by a problem of the hypothalamic-pituitary-adrenal axis as Cushing's syndrome but constitutes a heterogeneous group of disorders, either physiological (like surgery associated stress, severe illness or emotional stress) or non-physiological (like chronic alcoholism and withdrawal syndrome, major depression or poorly controlled diabetes mellitus) that lead to increased cortisol production and stigmata of hypercortisolism. The discrimination between CS and PCS is often difficult because many symptoms of CS are also prevalent in PCS. Furthermore, the substantial overlap of biochemical tests commonly used for the diagnosis of makes the differentiation of true, particularly mild CS from PCS challenging for the physician. Biochemical tests commonly used for the diagnosis of CS include midnight serum or salivary cortisol, dexamethasone-CRH Test and desmopressin Test. No test warrants 100% diagnostic accuracy and further studies with a larger number of patients with mild CS and pseudo-Cushing’s state evaluating the diagnostic accuracy of each of tests alone or their combination are necessary.