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Factitious hypercortisoluria
R J Workman1, W E Nicholson, D K McCammon
1Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
The Journal of Clinical Endocrinology and Metabolism
|October 1, 1995
Summary
This study presents a case of factitious hypercortisoluria caused by adding glucocorticoids to urine samples. Measuring both urine and plasma corticosterone is crucial for diagnosing factitious Cushing's syndrome.
Area of Science:
- Endocrinology
- Clinical Chemistry
Background:
- Factitious disorders involve intentional falsification of symptoms.
- Factitious hypercortisoluria presents a diagnostic challenge, mimicking genuine Cushing's syndrome.
Observation:
- A patient exhibited random fluctuations in urinary free cortisol levels.
- Plasma steroid hormone levels remained within normal limits.
- Urinary 17-hydroxycorticosteroid and free corticosterone levels were normal.
Findings:
- Discrepancies between plasma and urine steroid levels suggested sample tampering.
- Cortisol immunoactivity in urine coeluted with authentic cortisol via chromatography.
- The case highlights the importance of comprehensive steroid profiling.
Implications:
- This case underscores the diagnostic value of measuring urinary and plasma corticosterone.
- Accurate diagnosis of factitious Cushing's syndrome relies on meticulous evaluation of steroid profiles.
- Distinguishing factitious from genuine endocrine disorders requires careful clinical and laboratory assessment.