Q:

What are the causes of pseudo-Cushing’s syndrome?

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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 are the causes of pseudo-Cushing’s syndrome?

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• Some clinical features of Cushing’s syndrome may be present:8

– Pregnancy

– Depression and other psychiatric conditions

– Alcohol dependence

– Glucocorticoid resistance

– Morbid obesity

– Poorly controlled diabetes mellitus

• Unlikely to have any clinical features of Cushing’s syndrome:

– Physical stress (hospitalization, surgery, pain)

– Malnutrition, anorexia nervosa

– Intense chronic exercise

– Hypothalamic amenorrhea

– Cortisol-blinding globulin excess (increased serum but not urine

cortisol).

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