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. 2023 Jun 23;7(8):bvad087.
doi: 10.1210/jendso/bvad087. eCollection 2023 Jul 3.

Recognition of Nonneoplastic Hypercortisolism in the Evaluation of Patients With Cushing Syndrome

James W Findling  1   2 , Hershel Raff  1   2   3   4
Affiliations

Recognition of Nonneoplastic Hypercortisolism in the Evaluation of Patients With Cushing Syndrome

James W Findling et al. J Endocr Soc. .

Abstract

The evaluation of suspected hypercortisolism is one of the most challenging problems in medicine. The signs and symptoms described by Dr Harvey Cushing are common and often create diagnostic confusion to even experienced endocrinologists. Cushing syndrome is classically defined as neoplastic hypercortisolism resulting from an ACTH-secreting tumor or from autonomous secretion of excess cortisol associated with benign or malignant adrenal neoplasia. The increasing recognition of the negative cardiometabolic effects of mild cortisol excess without overt physical signs of Cushing syndrome has led to more screening for endogenous hypercortisolism in patients with adrenal nodular disease, osteoporosis, and the metabolic syndrome. However, sustained or intermittent activation of the dynamic hypothalamic-pituitary-adrenal axis caused by chemical (alcohol), inflammatory (chronic kidney disease), psychologic (major depression), and physical (starvation/chronic intense exercise) stimuli can result in clinical and/or biochemical features indistinguishable from neoplastic hypercortisolism. Nonneoplastic hypercortisolism (formerly known as pseudo-Cushing syndrome) has been recognized for more than 50 years and often causes diagnostic uncertainty. This expert consultation describes two patients with features of Cushing syndrome who were referred for inferior petrosal sinus sampling for the differential diagnosis of ACTH-dependent hypercortisolism. Both patients were discovered to have nonneoplastic hypercortisolism: one from a covert alcohol use disorder and the other to chronic kidney disease. This consultation emphasizes the value of a good history and physical examination, appropriate laboratory testing, and the desmopressin acetate stimulation test to aid in distinguishing neoplastic from nonneoplastic hypercortisolism.

Keywords: ACTH; Cushing disease; corticotrophs; cortisol; desmopressin; hypothalamic-pituitary-adrenal axis.

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Figures

Figure 1.
Figure 1.
Acute plasma ACTH and serum cortisol response to IV desmopressin (dDAVP) in our 2 cases, a sample of our patients with proven Cushing disease (CD Findling) and adapted from previously published data (CD Rollin) [33].
See this image and copyright information in PMC

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References

    1. Lindholm J. Cushing's syndrome: historical aspects. Pituitary. 2000;3(2):97‐104. - PubMed
    1. Medvei VC. The history of Cushing's disease: a controversial tale. J R Soc Med. 1991;84(6):363‐366. - PMC - PubMed
    1. Aron DC. Cushing's syndrome from bedside to bench and back: a historical perspective. Endocrinol Metab Clin North Am. 2005;34(2):257‐269, vii. - PubMed
    1. Kelsall A, Newell-Price J. Cushing's disease-from Minnie G to key issues in the early 21st century. Lancet Diabetes Endocrinol. 2019;7(12):959‐964. - PubMed
    1. Di Dalmazi G, Pasquali R, Beuschlein F, Reincke M. Subclinical hypercortisolism: a state, a syndrome, or a disease? Eur J Endocrinol. 2015;173(4):M61‐M71. - PubMed

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