A Rare Case of Hypercortisolemia Alongside Anorexia Nervosa

We present a case of anorexia nervosa (AN), which is a rare cause of hypercortisolism. We discuss the case of a female patient with a body mass index (BMI) of 12.4 kg/m² who was referred to us because of hypercortisolism. When the patient was evaluated for Cushing's syndrome (CS), the clinical presentation was not suggestive. However, hypercortisolism indicators showed CS. Pituitary and ectopic focus were not found in the radiological evaluation. The patient, who was noted not eating due to the fear of gaining weight, was consulted with a psychiatrist; a diagnosis of anorexia nervosa was made. Hypercortisolism is caused by conditions able to chronically activate the hypothalamic-pituitary-adrenal axis (HPAa), and although rare, it can also occur in psychiatric disorders such as AN. In patients diagnosed with AN, CS should be suspected if the typical clinical features of Cushing's syndrome are present. In AN-associated pseudo-Cushing's syndrome (PCS), an improvement in clinical features and laboratory parameters can be expected with appropriate weight gain. Recognizing PCS at presentation protects patients from unnecessary testing and treatment.