Fatal factitious Cushing syndrome (Münchhausen’s syndrome) in a patient with macroprolactinoma and silent corticotrophinoma: case report and literature review

Abstract

Münchhausen’s syndrome (MS) is a chronic factitious disorder characterized by the intentional production of clinical symptoms without external incentive. One type of MS is factitious Cushing syndrome, an extremely rare clinical situation in which the diagnosis is challenging mainly due to interference of the exogenous medication in cortisol immunoassays. We described a 26-year-old woman who was originally diagnosed with a macroprolactinoma and during follow-up developed clinical and laboratorial hypercortisolism. A transsphenoidal surgery was performed and immunohistochemistry revealed positive and diffuse staining for both hormones. Four years later, her hypercortisolism recurred and the confirmation of factitious Cushing syndrome was delayed due to conflicting laboratorial results.There are few cases in the literature of factitious Cushing syndrome, and only one had a fatal outcome. The diagnosis of this condition is complex and includes cyclic Cushing syndrome in the differential diagnosis. These patients have high morbidity and increased mortality risk and are likely to have other psychiatric disorders. Prednisone was identified as the culprit in the majority of the cases.

Factitious cushing’s syndrome with unusual presentation: a case report and literature review

“…Periodic CS and factitious CS have wide fluctuations in plasma or urine cortisol levels and ACTH. The periodicity of the fluctuations is the most important factor for distinguishing between the two conditions, with patients with periodic CS exhibiting fluctuations over days to months, while those with factitious CS typically exhibit rapid fluctuations, often appearing only when under supervision 5 .…”

“…Diagnosing Factitious CS is critical as it can lead to unnecessary and potentially harmful treatments, including surgical procedures to remove adrenal glands or pituitary tumors 5 . Furthermore, this syndrome can mimic actual CS, leading to delays in diagnosing the underlying medical conditions 6 .…”

Resolution of Cyclicity After Pasireotide LAR in a Patient With Cushing Disease

“…We published an intriguing case in which CIC was suspected due to the extensive hormonal variations (mainly in UC levels; false positive due to the method before mass spectrometry) and due to the purposeful use of oral prednisone. 14 …”