Endocrine Abstracts

Cushing's syndrome: pitfalls in diagnosis and management

Xavier Bertagna

Hôpital Cochin, Paris, France.

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Drug interactions, intercurrent pathological states may interfere with routine diagnostic tests. Authentic hypercortisolic states can be present without Cushing’s syndrome, such as in depression, anorexia nervosa, alcoholism, pregnancy. Mild forms of Cushing’s syndrome, or fluctuating cases are other usual pitfalls.

When the diagnosis of Cushing’s syndrome is firmly established there are still many potential pitfalls in the etiological diagnosis of Cushing’s syndrome: Cushing’s disease mimicking an autonomous adrenal tumor, severe Cushing’s disease mimicking the classical ectopic ACTH syndrome, mild ectopic ACTH syndrome mimicking the classic Cushing’s disease, and the cases of ACTH-independent Cushing’s syndrome where the two adrenals are involved (AIMAH, and PPNAD).

Management of patients through pituitary surgery, adrenal surgery, anticortisolic drugs offer many other situations with potential pitfalls.

All these situations will be approached through case presentations.

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Endocrine Abstracts (2009) 20 ME8