Factitious Cushing's syndrome: discovery with use of a sensitive immunoradiometric assay for corticotropin.

Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
I M O'ShaughnessyJ W Findling

Abstract

Factitious Cushing's syndrome is an unusual problem that may be clinically and biochemically indistinguishable from endogenous hypercortisolism. Results of biochemical studies may be misleading because of cross-reactivity of synthetic corticosteroids or their metabolites with plasma or urine cortisol. Because of its lack of specificity, radioimmunoassay (RIA) for corticotropin (adrenocorticotropic hormone or ACTH) may not show completely suppressed results in patients with surreptitious use of glucocorticoids. A new sensitive and specific immunoradiometric assay (IRMA) for ACTH demonstrates reliably suppressed levels after administration of glucocorticoids. In this report, we describe a 37-year-old woman with typical clinical and biochemical features of ACTH-dependent hypercortisolism. Metabolic evaluation had shown urinary free cortisol excretion of 7,499 nmol/day and plasma ACTH-RIA levels of 13.2 and 33.0 pmol/L on two separate occasions. The use of IRMA for the measurement of ACTH during inferior petrosal sinus sampling revealed a very low peripheral ACTH concentration (=0.4 pmol/L) and a considerably blunted response to ovine corticotropin-releasing hormone, findings that suggested ACTH-independent Cushing's syndrome. Plas...Continue Reading

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Citations

Sep 27, 2001·Endocrinology and Metabolism Clinics of North America·J W Findling, H Raff
Apr 27, 2005·Endocrinology and Metabolism Clinics of North America·John R Lindsay, Lynnette K Nieman
Aug 15, 2012·Nature Reviews. Endocrinology·Ilias PerogamvrosPeter J Trainer
Oct 12, 2013·Clinical Endocrinology·Tilenka ThynneMorton G Burt
May 3, 2011·Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete·S Ugurel, J C Becker
Jan 13, 2004·Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists·Bachar AfandiHussein F Saadi
Mar 20, 2019·Frontiers in Endocrinology·Maria M PineyroMarcelo Viola

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