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A 29-year-old female presented with progressive swelling over the body, weight gain, menstrual irregularity. On examination, her BP was 160/100 mm Hg, pulse rate 86/min, weight 88 kg, height 155 cm. Buffalo hump was present with broad purplish striae over the abdomen. Proximal muscle weakness was present. Her investigations revealed Hb 12.6 g%, fasting blood sugar (FBS) 170 mg%, creatinine 0.9, Na 140 mEq/L, K 3.4 mEq/L (Fig. 2.1).
What other relevant clinical evaluation would you like to do?
Medicine
We would like to check for complications of excessive steroid and rule out pseudo-Cushing’s syndrome and take treatment history regarding exogenous steroid administration. Pseudo-Cushing’s syndrome is characterized by mild hypercortisolism and may be difficult to distinguish from true Cushing’s syndrome. Causes include depression, alcoholism, medications, obesity, psychiatric illness, stress/trauma/ acute illness, and states of elevated cortisol-binding protein (pregnancy, estrogen therapy). Pseudo-Cushing’s syndrome may produce results suggestive of hypercortisolism, abnormal dexamethasone suppressibility and mild elevation of urinary free cortisol (UFC). The distinguishing feature of this disorder is that
the laboratory and clinical findings of hypercortisolism disappear if the primary process is successfully treated. The metabolic syndrome which is characterized by central obesity, hypertension, and glucose intolerance may mimic Cushing’s syndrome. The polycystic ovarian syndrome may present with menstrual irregularities and hyperandrogenism (hirsutism, acne) similar to features of Cushing’s syndrome.
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