Seudo-Cushing alcohólico: presentación de un caso

Suárez, Saturnino; Zarzalejos, Jose María; Delgado, Juan; Alonso, Bettina; Pérez-Correa, S.; Conde, Alicia

doi:10.1016/s1575-0922(04)74596-9

Cited by 1 publication

(1 citation statement)

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“…Patients with AIH may have physical and clinical features and abnormal laboratory findings similar to neoplastic hypercortisolism. (For images of patients with AIH, see [ 35 , 36 ]). Many studies have confirmed increased cortisol secretion during heavy alcohol use detected with hair cortisol [ 37 ], cortisol awakening response [ 38 ], overnight urinary cortisol [ 39 ], and plasma [ 40 ] and LNSC [ 41 ].…”

Section: Discussion Of Casesmentioning

confidence: 99%

Recognition of Nonneoplastic Hypercortisolism in the Evaluation of Patients With Cushing Syndrome

Findling

Raff

2023

Journal of the Endocrine Society

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The evaluation of suspected hypercortisolism is one of the most challenging problems in medicine. The signs and symptoms described by Dr Harvey Cushing are common and often create diagnostic confusion to even experienced endocrinologists. Cushing syndrome is classically defined as neoplastic hypercortisolism due to an ACTH-secreting tumor or to autonomous secretion of excess cortisol associated with benign or malignant adrenal neoplasia. The increasing recognition of the negative cardiometabolic effects of mild cortisol excess without overt physical signs of Cushing syndrome has led to more screening for endogenous hypercortisolism in patients with adrenal nodular disease, osteoporosis, and the metabolic syndrome. However, sustained or intermittent activation of the dynamic hypothalamic-pituitary-adrenal axis caused by chemical (alcohol), inflammatory (chronic kidney disease), psychologic (major depression), and physical (starvation/chronic intense exercise) stimuli can result in clinical and/or biochemical features indistinguishable from neoplastic hypercortisolism. Non-neoplastic hypercortisolism (formerly known as pseudo-Cushing syndrome) has been recognized for over fifty years and often causes diagnostic uncertainty. This expert consultation describes two patients with features of Cushing syndrome who were referred for inferior petrosal sinus sampling for the differential diagnosis of ACTH-dependent hypercortisolism. Both patients were discovered to have non-neoplastic hypercortisolism—one due to a covert alcohol use disorder and the other to chronic kidney disease. This consultation emphasizes the value of a good history and physical examination, appropriate laboratory testing, and the desmopressin acetate (dDAVP) stimulation test to aid in distinguishing neoplastic from non-neoplastic hypercortisolism.

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