eMedicine Specialties > Endocrinology > Adrenal Gland

Pseudo-Cushing Syndrome

Author: David M Klachko, MBBCh, Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Missouri
Contributor Information and Disclosures

Updated: Oct 29, 2009

Introduction

Background

In 1976, Smalls and associates described 3 alcoholic patients who had the physical and biochemical abnormalities of Cushing syndrome.1 Most of the abnormalities disappeared with 1-3 weeks of alcohol abstinence. About 30 cases have been reported. Similar abnormalities have also been described in patients with depression.2,3,4,5,6

Recent studies
A study by Dockray et al of 111 children of both sexes, ages 8-13 years, suggested that depression-related increases in cortisol reactivity may be associated with childhood obesity in girls.2 Symptoms of depression in the study participants were assessed using the Child Behavior Checklist, while the children's cortisol reactivity was measured in response to the Trier Social Stress Test for Children. Although the results indicated that in boys and girls a positive association exists between depression and body mass index, cortisol reactivity as an apparent mediating factor was found only in girls.

Pathophysiology

The mechanism remains unclear. Most evidence suggests central stimulation of a corticotropin-releasing hormone, either at the hypothalamic or suprahypothalamic level. Rats given 15% alcohol for 3 months showed increased numbers and increased secretory activity of corticotropin-producing cells.

Frequency

United States

In a study of 56 men in an alcohol detoxification unit, 18% had nonsuppressible serum cortisol levels. Many of these patients lacked the physical stigmata of Cushing syndrome, and some biochemical abnormalities resolved in a few days.

Mortality/Morbidity

  • No deaths have been reported.
  • Persistence of abnormalities may lead to complications such as hypertension, glucose intolerance, diabetes mellitus, and osteoporosis.

Sex

Pseudo-Cushing syndrome occurs equally in men and women.

Age

Pseudo-Cushing syndrome occurs in people of any age, and it may occur in babies exposed to alcohol in breast milk.

Clinical

History

The most important part of the history is the extent and duration of alcohol abuse. Similar factors should be assessed in regard to depression.2,3,4,5,6

Physical

  • Features of full-blown Cushing syndrome
    • Truncal obesity
    • Plethoric moon face
    • Buffalo hump
    • Supraclavicular fat pads
    • Hirsutism in women
    • Thin skin with easy bruising and wide, purplish striae
    • Hypertension
  • Other patients have only a few symptoms or no physical evidence of glucocorticoid excess.

Causes

  • The reason some alcoholic patients develop the problem and others do not is unknown.
  • Because biochemical abnormalities can resolve after a few days of alcohol abstinence, it may require long periods of excessive alcohol intake for the full syndrome to develop.
  • Attempts to find a genetic predisposition have been unsuccessful.

More on Pseudo-Cushing Syndrome

Overview: Pseudo-Cushing Syndrome
Differential Diagnoses & Workup: Pseudo-Cushing Syndrome
Treatment & Medication: Pseudo-Cushing Syndrome
Follow-up: Pseudo-Cushing Syndrome
References
Further Reading
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References

  1. Smalls AG, Kloppenborg PW, Njo KT. Alcohol-induced Cushingoid syndrome. Br Med J. Nov 27 1976;2(6047):1298. [Medline].

  2. Dockray S, Susman EJ, Dorn LD. Depression, cortisol reactivity, and obesity in childhood and adolescence. J Adolesc Health. Oct 2009;45(4):344-50. [Medline].

  3. Elzinga BM, Spinhoven P, Berretty E, et al. The role of childhood abuse in HPA-axis reactivity in Social Anxiety Disorder: a pilot study. Biol Psychol. Sep 16 2009;[Medline].

  4. Hinkelmann K, Moritz S, Botzenhardt J, et al. Cognitive impairment in major depression: association with salivary cortisol. Biol Psychiatry. Nov 1 2009;66(9):879-85. [Medline].

  5. Dougherty LR, Klein DN, Olino TM, et al. Increased waking salivary cortisol and depression risk in preschoolers: the role of maternal history of melancholic depression and early child temperament. J Child Psychol Psychiatry. Jul 21 2009;[Medline].

  6. Sephton SE, Dhabhar FS, Keuroghlian AS, et al. Depression, cortisol, and suppressed cell-mediated immunity in metastatic breast cancer. Brain Behav Immun. Jul 28 2009;[Medline].

  7. Adler RA. Clinical review 33: Clinically important effects of alcohol on endocrine function. J Clin Endocrinol Metab. May 1992;74(5):957-60. [Medline].

  8. Binkiewicz A, Robinson MJ, Senior B. Pseudo-Cushing syndrome caused by alcohol in breast milk. J Pediatr. Dec 1978;93(6):965-7. [Medline].

  9. Cunningham JM, Buxton OM, Weiss RE. Circadian variation in Cushing's disease and pseudo-Cushing states by analysis of F and ACTH pulsatility. J Endocrinol Invest. Oct 2002;25(9):791-9. [Medline].

  10. Groote Veldman R, Meinders AE. On the mechanism of alcohol-induced pseudo-Cushing''s syndrome. Endocr Rev. Jun 1996;17(3):262-8. [Medline].

  11. Kapcala LP. Alcohol-induced pseudo-Cushing's syndrome mimicking Cushing's disease in a patient with an adrenal mass. Am J Med. Apr 1987;82(4):849-56. [Medline].

  12. Kirkman S, Nelson DH. Alcohol-induced pseudo-Cushing's disease: a study of prevalence with review of the literature. Metabolism. Apr 1988;37(4):390-4. [Medline].

  13. Makras P. Toloumis G. Papadogias D. Kaltsas GA. Besser M. The diagnosis and differential diagnosis of endogenous Cushing's syndrome. [Review] [139 refs]. Hormones. Oct-Dec 2006;5(4):231-50. [Medline].

  14. Moro M, Putignano P, Losa M. The desmopressin test in the differential diagnosis between Cushing's disease and pseudo-Cushing states. J Clin Endocrinol Metab. Oct 2000;85(10):3569-74. [Medline].

  15. Nieman LK. Diagnostic tests for Cushing's syndrome. Ann N Y Acad Sci. Sep 2002;970:112-8. [Medline].

  16. Papanicolaou DA, Yanovski JA, Cutler GB Jr. A single midnight serum cortisol measurement distinguishes Cushing's syndrome from pseudo-Cushing states. J Clin Endocrinol Metab. Apr 1998;83(4):1163-7. [Medline].

  17. Somer L, Matavulj M, Hadzic B. [The hypophyseal-adrenal axis in chronic alcoholism]. Medicinski Pregled. 1996;49:349-355.

  18. Vogeser M. Durner J. Seliger E. Auernhammer C. Measurement of late-night salivary cortisol with an automated immunoassay system. Clinical Chemistry & Laboratory Medicine. 2006;44(12):1441-5. [Medline].

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Keywords

pseudo-Cushing syndrome, Cushings syndrome, Cushing's syndrome, Cushing syndrome, cortisol, Cushings disease, Cushing's disease, Cushing disease, pseudo-Cushing's syndrome, alcohol-induced Cushing syndrome, adrenocortical secretion, Cushing basophilism, corticotropin-releasing hormone

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Contributor Information and Disclosures

Author

David M Klachko, MBBCh, Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Missouri
David M Klachko, MBBCh is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Federation for Medical Research, Endocrine Society, Missouri State Medical Association, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Steven R Gambert, MD, MACP, Chairman, Department of Medicine, Physician-in-Chief, Sinai Hospital of Baltimore; Professor of Medicine, Program Director, Internal Medicine Program, Johns Hopkins University School of Medicine
Steven R Gambert, MD, MACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American Geriatrics Society, Association of Professors of Medicine, Endocrine Society, and Gerontological Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Yoram Shenker, MD, Chief of Endocrinology Section, Veterans Affairs Medical Center of Madison; Interim Chief, Associate Professor, Department of Internal Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Wisconsin at Madison
Yoram Shenker, MD is a member of the following medical societies: American Heart Association, Central Society for Clinical Research, and Endocrine Society
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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