Endocrine Abstracts

Introduction and importance: Pseudo-Cushing’s syndrome (PCS) encompasses a spectrum of medical conditions, both physiological and non-physiological, that replicate the clinical features of Cushing’s syndrome (CS). In PCS, there is a presence of mild biochemical hypercortisolaemia, which is carefully regulated by physiological feedback hormonal control mechanisms. Physiological conditions contributing to PCS include factors like pregnancy surgical or emotional stress, severe illness, intense chronic exercise, while non-physiological contributors encompass chronic alcoholism, obesity metabolic syndrome, poorly controlled diabetes mellitus, major depression, malnutrition, and anorexia nervosa. The differentiation between pseudo-Cushing’s states (PCS) and Cushing’s syndrome (CS) presents a significant clinical puzzle, posing a formidable challenge even for experienced endocrinologists.

Case presentation: We present the case of a 46-year-old patient with no History of diabetes mellitus, depression, or excessive alcohol intake. The patient was admitted for the exploration of a pituitary macroadenoma; pituitary contrast-enhanced MRI showed a pituitary tumour (11×11×7.5 mm). Clinical examination revealed a Grade I obesity (body mass index 33 kg/m²) with an android phenotype, along with a moon face and a buffalo hump. Secretory assessments were conducted: The midnight cortisol level came back elevated (67 ng/dl), a 24-hour urine collection showed a normal level of free cortisol, and overnight administration of 1 mg of dexamethasone reduced the serum cortisol level. And additional investigations have been supplemented by a standard dexamethasone suppression test; the patient demonstrated appropriate suppression during the conducted test.

Conclusion: PCS, a condition mimicking overt hypercortisolism, poses a considerable challenge in the differential diagnosis with Cushing’s disease (CD). Patients with obesity metabolic syndrome, polycystic ovary syndrome, chronic alcoholism, depression, and extreme physical stress are recognized as prone to developing PCS. Obese individuals, such as our patient, have been reported to exhibit hyperactivation of the hypothalamus–pituitary–adrenal (HPA) axis in response to both physical and psychosocial stressors. The concomitant discover, of a non-functioning pituitary adenoma added complexit, to the diagnosis in our case.