A cluster of cases of factitious Cushing's syndrome.
OBJECTIVE
To review the patient profiles, laboratory data, and diagnostic approaches in factitious administration of glucocorticoids.


METHODS
Four cases of surreptitious use of glucocorticoids are presented. Clinical and laboratory data as well as imaging studies are summarized. Pertinent case reports in the literature are reviewed.


RESULTS
We report four cases of surreptitious use of glucocorticoids encountered within a 2-year period. All four patients were women without significant psychiatric histories. In three patients, the question of factitious Cushing's syndrome was suspected because of physical evidence or symptoms of Cushing's syndrome (or both) in the setting of suppressed cortisol levels. The fourth patient had undetectable cortisol levels in both serum and 24-hour urine samples but did not have signs or symptoms of adrenal insufficiency. In three cases, the diagnosis was confirmed by direct measurement of synthetic glucocorticoids in the patient's urine or serum. The fourth case was diagnosed by correlating increased cortisol levels with decreased precursor adrenal steroids.


CONCLUSIONS
Exogenous corticosteroid use in the absence of a medical indication poses a serious risk to a patient. This possibility should be considered in patients with signs and symptoms consistent with Cushing's syndrome but with low serum and urinary cortisol levels. Similarly, this diagnosis should be suggested in patients without symptoms of adrenal insufficiency and with low cortisol levels. Laboratory measurement of synthetic steroids can be helpful in confirming the diagnosis.
Villanueva
R B
RB
Division of Endocrinology, Bronfman Department of Medicine, Mount Sinai Hospital and Mount Sinai School of Medicine of New York University, New York, New York 10029, USA.
Brett
E
E
Gabrilove
J L
JL
D015065:17-Hydroxycorticosteroids / Q000097:blood; D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000097:blood; D000324:Adrenocorticotropic Hormone / Q000097:blood; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000523:psychology; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D005260:Female; D006728:Hormones / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008875:Middle Aged; D009110:Munchausen Syndrome / Q000175:diagnosis* / Q000523:psychology
D015065:17-Hydroxycorticosteroids; D000305:Adrenal Cortex Hormones; D006728:Hormones; D019314:Dehydroepiandrosterone Sulfate; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone