56-year-old woman with alcoholic liver disease presents complains of being tired

The symptoms of pseudo-Cushing syndrome are often indistinguishable from those of Cushing syndrome

This patient is likely to have pseudo-Cushing syndrome. Depression, obesity, and alcoholism are all conditions that can lead to this diagnosis. It is important to make an appropriate diagnosis to avoid treating a patient who does not have true Cushing syndrome and an endocrinologist can provide advice on appropriate testing. Ideally, tests need repeating following a period of abstinence, as abstinence usually results in complete resolution of the physiological increase in serum cortisol levels. The symptoms of pseudo-Cushing syndrome are often indistinguishable from that of Cushing syndrome.

Reference:

Alwani RA, Schmit Jongbloed LW, de Jong FH, et al. Differentiating between Cushing's disease and pseudo-Cushing's syndrome: comparison of four tests. Eur J Endocrinol. 2014;170(4):477-486.

Nieman LK. Cushing's syndrome: update on signs, symptoms and biochemical screening. Eur J Endocrinol. 2015;173(4):M33-8.

Nieman LK. Causes and pathophysiology of Cushing's syndrome. Updated May 2014, Accessed January 30th 2017.

McPherson RA, Pincus MR. Henry's Clinical Diagnosis and Management by Laboratory Methods. 23rd ed., 2016.

Stewart PM, Newell-Price JD. The adrenal cortex. In: Melmed S, Polonsky KS. Williams Textbook of Endocrinology. 13th ed., 2016: 489-555.

Yanovski JA, Cutler GB Jr, Chrousos GP, Nieman LK. The dexamethasone-suppressed corticotropin-releasing hormone stimulation test differentiates mild Cushing's disease from normal physiology. J Clin Endocrinol Metab. 1998;83(2):348-352.