[Factitious Cushing syndrome: two case reports].
BACKGROUND
Search of corticosteroid use is an important precaution before any exploration of hypercorticism. Nevertheless, this use may be factitious leading to serious misdiagnosis and pitfalls.


METHODS
We report two cases of 29 and 60 years old male patients, referred for hypercorticism with patent features including metabolic and trophical signs. Laboratories findings revealed unelevated urinary cortisol values (40 and 27 microg/ day) in both cases with normal ACTH and normal plasmatic cortisol response to synacthène (32,5 and 35 microg/dl). Corticosteroid use, initially denied, was finally approved by the patients (hydrocortisone and dexamethasone for the first patient and betametasone for the second). So, they were assigned to psychiatric therapy.


CONCLUSIONS
Our cases emphasize that corticosteroid misuse must be evoked in patients with unexpected hormonal assessment of pituitary adrenal axis despite patent clinical features of hypercorticism. Several specific tests are actually available for detect factitious Cushing syndrome. However, differential diagnostic remains difficult mainly with pseudo Cushing and cyclical Cushing syndromes.
Ach
K
K
Service d'endocrinologie-diabétologie du Professeur L.-Chaieb, CHU Farhat-Hached, Sousse, Tunisie. achkoussay@topnet.tn
Khochtali
I
I
Ajmi
S Trimech
ST
Beizig
A Maaroufi
AM
Chadli
M Chaieb
MC
Ajina
M Zaouali
MZ
Chaieb
L
L
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D003480:Cushing Syndrome / Q000175:diagnosis*; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D006801:Humans; D008297:Male; D008875:Middle Aged; D019966:Substance-Related Disorders
D000305:Adrenal Cortex Hormones