Q:

What is the importance of diagnosing pseudo-Cushing’s state?

waelhammad
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2022-11-18
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A 47-year-old lady with complaints of decreased ability to sleep has been admitted under the department of psychiatry and found to have depression with generalized anxiety disorder. She has also been diagnosed with diabetes and hypertension for 4 years for which she is on metformin 2 g/day with glimepiride 4 mg/day and amlodipine 10 mg/day. She has oligoamenorrhea for many years and has cycles only after taking medroxyprogesterone acetate for 5 days. On examination, her BMI is 31 kg/m2, has waist circumference of 102 cm, acanthosis nigricans, no striae or bruising. Blood pressure of 140/90 mm Hg. Her psychiatry consultant wants to rule out Cushing’s syndrome as a cause of the depression and metabolic features. What would you do next?

What is the importance of diagnosing pseudo-Cushing’s state?

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waelhammad
2022-11-18
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It is quite important to determine if the patient has Cushing’s syndrome or a pseudo-Cushing’s state in a time- and cost-effective manner, because if a patient with a pseudo-Cushing’s state is misdiagnosed as having Cushing’s syndrome, that patient could undergo needless testing and unnecessary surgery. On the other hand, it is important to identify Cushing’s syndrome accurately as it is a condition with increased mortality and morbidity.

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