A woman presenting with hypercortisolism

Cushing’s syndrome is the result of extended exposure to excessive glucocorticoids from endogenous or exogenous sources (1). The most common cause of endogenous Cushing’s syndrome is a pituitary adenoma (Cushing disease). Less common causes are adrenocortical tumors and extrapituitary adrenocorticotropinproducing neoplasias. Cushing’s syndrome is challenging to diagnose (2). During the last decades a condition named ‘Pseudo-Cushing’ has been described (3). In this medical condition patients display signs, symptoms, and abnormal hormone levels as seen in Cushing's syndrome. The glucocorticoid excess may be caused by alcohol abuse, anorexia nervosa, visceral obesity, and depression. These conditions with secondary glucocorticoid excess can make the diagnosis of Cushing’s syndrome particularly difficult (4). This case report describes the diagnostic challenges we met to discriminate between Cushing’s syndrome and ‘Pseudo-Cushing’.