Differential diagnosis and treatment of steroid-induced affective syndromes

The differential diagnosis of hypercortisolemia is complex, particularly when the clinician must distinguish Cushing's syndrome (CS) from major depression. The present clinical case history demonstrates that by means of physical and laboratory examinations, the psychiatrist can make the initial differentiation, in consultation with medical specialists. The use of the corticotropin-releasing factor (CRF) stimulation test may be especially helpful in distinguishing Cushing's disease (CD) from major depression, though there is some degree of "overlap" in results. This suggests that these disorders may lie along a continuum of hypothalamopituitary dysfunction.