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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
PubMed
Summary
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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.

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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.