Le syndrome de Cushing factice : deux observations

Ach, K.; Khochtali, I.; Ajmi, S.; Beizig, A. Maaroufi; Chadli, M.; Ajina, Mounir; Chaieb, L.

doi:10.1016/j.revmed.2005.07.011

Cited by 4 publications

(4 citation statements)

References 14 publications

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“…The diagnosis of this condition is complex and includes cyclic CS in the differential diagnosis. The difference between these possible diagnoses is the periodicity of hormone fluctuation, which can take years in the case of cyclic CS but can change dramatically over short periods of time in factitious CS [4–6]. Another clue can be provided by DHEA-S measurements, as ACTH-dependent CS is associated with normal/high levels of this hormone.…”

Section: Discussionmentioning

confidence: 99%

“…The medical history of these cases included drug addiction in 19 % and psychiatric disorders in 57 %, mainly depression and anxiety, and 42 % of patients had personal contact with health professionals. In regard to laboratory tests, 48 % of cases showed unsuppressed ACTH levels, and 66 % also showed elevated UFC at the same time [1–3, 6–11, 13, 14]. In addition, one-third of patients presented a suspicious pituitary MRI [1, 7].…”

Section: Discussionmentioning

confidence: 99%

“…Only three cases in the literature reported DHEA-S measurements, and all of them were suppressed [1, 9]. Half of the reported patients showed normal adrenal glands on abdominal imaging [1–3, 6, 9–12]. Prednisone was identified as the culprit in the majority of the cases [1, 3, 10, 12].…”

Section: Discussionmentioning

confidence: 99%

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

Minanni¹,

Cardoso²,

Albuquerque³

et al. 2015

Clin Diabetes Endocrinol

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Minanni¹,

Cardoso²,

Albuquerque³

et al. 2015

Clin Diabetes Endocrinol

View full text Add to dashboard Cite

show abstract

“…As well as clinical features, also the biochemical profile of the HPA axis can be extremely heterogeneous in patients with factitious CS. Indeed, plasma ACTH and serum or urinary cortisol values are very low in some cases, but normal or increased in other ones (6,10,11). In some patients, the biochemical profile mimics Cushing's disease, and MRI can incidentally detect small pituitary lesions (12).…”

Section: Discussionmentioning

confidence: 99%

Factitious Cushing’s syndrome, hypopituitarism, and self-provoked skin lesions: when the skin mirrors the soul

Cannavò

2021

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary Factitious Cushing’s syndrome (CS) is a very rare form of Münchausen syndrome. Its presentation and course are extremely heterogeneous, and diagnosis is generally challenging. We report the case of a 52-year-old woman who was initially investigated because of the occurrence of cushingoid features. Nevertheless, endocrine work-up showed very low morning plasma ACTH and serum cortisol levels. In addition, it also demonstrated central hypopituitarism and hypogonadotropic hypogonadism. Head MRI showed a small pituitary mass. Based on these results, and probably overlooking the initial clinical suspicion, general practitioner (GP) referred the patient to our Endocrine Unit for hypopituitarism. At inspection, moon face, central obesity, and bruising were evident. Multiple ulcerative skin lesions were also concentrated in the right arm and leg. Dermatology evaluation suggested that the lesions were self-provoked. For several days, the patient denied the assumption of corticosteroids, but we finally discovered that the GP’ nurse had prescribed betamethasone without the GP’s knowledge for about 2 years. In conclusion, the surreptitious assumption of corticosteroids is very rare, but the physicians should be aware that pituitary function could be impaired by high doses of corticosteroids, mimicking hypopituitarism. In these patients, a multidisciplinary approach and environmental investigation can be useful to diagnose factitious CS. Learning points Surreptitious assumption of corticosteroids can cause heterogeneous presentation, ranging from Cushing’s syndrome to multiple hypopituitarism. Suppression of ACTH and cortisol levels in a patient with cushingoid features firstly suggests surreptitious assumption of corticosteroids. A multidisciplinary approach can be extremely useful in patients with suspected factitious Cushing’s syndrome. Sometimes, to prove surreptitious assumption of corticosteroids needs environmental investigation.

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A new illicit opioid dependence outbreak, evidence for a combination of opioids and steroids

Koushesh¹,

Afshari

2009

Drug and Chemical Toxicology

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Opioid abuse is common in Iran. In 2005, a new version of locally produced illicit opioid vials, so called Norgesic, appeared in the illicit market, which gained popularity rapidly and led to an improvement of stigmatizing the general appearance of dependent cases. Later, some cases suffered Cushing's-like problems. A prospective case series was designed to evaluate 18 Norgesic-dependent subjects who volunteered for abstinence therapy in a rehabilitation clinic from November 1, 2005, to December 30, 2005. In this study, we aimed to describe the clinical and paraclinical findings in detail and define the potential determinants of this Cushing's syndrome outbreak. History, physical examination, plasma cortisol level, and urine screen tests were used to describe the patients. All subjects were male with a mean (SEM) age of 29.8 +/- 1.6 years. The opioid-dependence period was 8.4 +/-0.9 years. In an average of 4.7 +/- 0.3 months, subjects increased their usage to 5.5 +/- 0.5 vials a day. Patients claimed to gain weight. Striae were seen in 38.9%, previously documented psychological problems in 33.3%, weakness in 27.8%, high systolic blood pressure in 22.2%, moon face in 16.7%, hirsutism in 11.1%, extensive dermal infection in 11.1%, gynecomastia in 5.6%, back pain in 5.6%, insomnia in 5.6%, and lack of potency in 5.6%. Their cortisol level, on average, was 4.8 +/- 1.1 microg/dL. Hepatitis C virus was positive in 22.2%. Urine-screening tests were positive for morphine and negative for buprenorphine. In conclusion, these new vials contain steroids as well as opioids. This combination could be more dangerous than opioids themselves.

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Le syndrome de Cushing factice : deux observations

Cited by 4 publications

References 14 publications

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

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

Factitious Cushing’s syndrome, hypopituitarism, and self-provoked skin lesions: when the skin mirrors the soul

A new illicit opioid dependence outbreak, evidence for a combination of opioids and steroids

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