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

A 56-year-old woman with alcoholic liver disease presents to you with the complaint of being tired but states that she is otherwise healthy. She currently drinks 3 six-packs of beer every day and tells you she is not interested in alcohol cessation.

On examination, her height is 5 feet 6 inches, she weighs 186 pounds, and her blood pressure is 147/84 mm Hg. She has a buffalo hump and striae in the abdomen that are pink in color. She is able to stand up after squatting.

Her nonfasting, finger-stick blood glucose test result is 189. On initial work-up, you order a morning cortisol level, which is 16 mg/dL, and a glycated hemoglobin level, which is 7.3%.

You confirm a diagnosis of diabetes but you are concerned the patient may have Cushing syndrome given her elevated cortisol level. You order a dexamethasone suppression test (1 mg), which comes back as 14 mg/dL.

Which of the following statements is true of patients with pseudo-Cushing syndrome associated with alcohol abuse?

• Chronic alcohol use results in a physiological decrease in serum cortisol levels
• Patients with pseudo-Cushing syndrome secondary to alcohol abuse require the same treatment as patients with Cushing syndrome
• Cortisol levels in pseudo-Cushing syndrome remain high even after a period of abstinence
• The symptoms of pseudo-Cushing syndrome are often indistinguishable from those of Cushing syndrome

This question appears in Med-Challenger Family Nurse Practitioner Exam Review with CME

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