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[Factitious Cushing syndrome: two case reports].

K Ach1, I Khochtali, S Trimech Ajmi

  • 1Service d'endocrinologie-diabétologie du Professeur L.-Chaieb, CHU Farhat-Hached, Sousse, Tunisie. achkoussay@topnet.tn

La Revue De Medecine Interne
|October 26, 2005
PubMed
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Factitious corticosteroid use can mimic hypercorticism, leading to misdiagnosis. Always consider exogenous corticosteroid misuse in patients with unexplained hormonal imbalances and Cushingoid features.

Area of Science:

  • Endocrinology
  • Internal Medicine
  • Clinical Diagnostics

Background:

  • Corticosteroid use is a critical consideration in hypercorticism evaluation.
  • Factitious corticosteroid use can lead to significant misdiagnosis and clinical pitfalls.

Observation:

  • Two male patients (29 and 60 years old) presented with clear signs of hypercorticism.
  • Hormonal assessments, including urinary cortisol, ACTH, and synacthène response, were unexpectedly normal.
  • Patients initially denied, but later admitted to, exogenous corticosteroid use (hydrocortisone, dexamethasone, betamethasone).

Findings:

  • Exogenous corticosteroid misuse can present with clinical features of hypercorticism but normal pituitary-adrenal axis markers.
  • Normal laboratory findings despite apparent hypercorticism should prompt investigation into factitious corticosteroid use.

Related Experiment Videos

Implications:

  • Evoking corticosteroid misuse is crucial for accurate diagnosis in suspected hypercorticism.
  • Differentiating factitious Cushing syndrome from pseudo-Cushing and cyclical Cushing syndromes can be challenging.
  • Psychiatric evaluation and therapy are indicated for patients with factitious corticosteroid use.