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    Area of Science:

    • Endocrinology
    • Internal Medicine

    Background:

    • Differentiating Cushing's syndrome from pseudo-Cushing states presents a significant clinical difficulty.
    • Endocrinologists frequently encounter challenges in definitively diagnosing these conditions due to overlapping symptoms and test results.

    Purpose of the Study:

    • To highlight the diagnostic challenges in distinguishing Cushing's syndrome from pseudo-Cushing states.
    • To emphasize the need for careful evaluation in cases with mild clinical presentation and borderline laboratory findings.

    Main Methods:

    • This study is a review of clinical and diagnostic challenges.
    • It synthesizes information on epidemiological factors, clinical overlap, and test variability.

    Main Results:

    • No single factor definitively distinguishes Cushing's syndrome from pseudo-Cushing.
    • Variability in diagnostic test responses complicates accurate diagnosis.

    Conclusions:

    • Extreme caution is necessary when diagnosing or excluding Cushing's syndrome, particularly in patients with subtle clinical signs and equivocal test results.
    • Further research may be needed to refine diagnostic criteria and improve differentiation.