Polycystic ovarian syndrome and Cushing's syndrome: a persistent diagnostic quandary.
OBJECTIVE
To retrospectively review institutional records of female patients of reproductive age with Cushing's disease (CD) and determine if and how many had been previously diagnosed as having solely polycystic ovarian syndrome (PCOS). To determine whether clinical patterns might be useful in identifying appropriate candidates for hypercortisolism screening in women suspected of PCOS.


METHODS
The study included 50 patients with pathologically proven CD at Oregon Health & Science University, Northwest Pituitary Center between 2006 and 2011. Physical, clinical, and biochemical features for hypercortisolism were compared.


RESULTS
Of 50 patients with pathologically proven CD, 26 were women of reproductive age. Of these, half had previously been diagnosed with and treated initially solely for PCOS. Hirsutism and menstrual abnormalities were more common in the group with an initial PCOS diagnosis than in the group with an initial CD diagnosis.


CONCLUSIONS
Prolonged exposure to hypercortisolism has been linked with increased mortality and morbidity. Tests for hypercortisolism in all the PCOS cases we report led to an appropriate CD diagnosis. Future research should focus on when and which (if not all) women with suspected PCOS should be tested for hypercortisolism.
Department of Medicine, Division of Endocrinology, Portland, OR, USA.
Jessica
J
Brzana
Department of Neurological Surgery, Portland, OR, USA; Northwest Pituitary Center, Oregon Health & Science University, Portland, OR, USA.
Christine G
CG
Yedinak
Department of Medicine, Division of Endocrinology, Portland, OR, USA.
Nadia
N
Hameed
Department of Medicine, Division of Endocrinology, Portland, OR, USA.
Adeline
A
Plesiu
Department of Neurological Surgery, Portland, OR, USA; Northwest Pituitary Center, Oregon Health & Science University, Portland, OR, USA.
Shirley
S
McCartney
Department of Medicine, Division of Endocrinology, Portland, OR, USA; Department of Neurological Surgery, Portland, OR, USA; Northwest Pituitary Center, Oregon Health & Science University, Portland, OR, USA. Electronic address: fleseriu@ohsu.edu.
Maria
M
Fleseriu
D000328:Adult; D003480:Cushing Syndrome / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011085:Polycystic Ovary Syndrome / Q000175:diagnosis*; D012189:Retrospective Studies
Cushing's disease; Cushing's syndrome; Diagnosis; Hypercortisolism; Polycystic ovary syndrome; Screening