Factitious Cushing syndrome: two case reports

Introduction. - Search of corticosteroid use is an important precaution before any exploration of hypercorticisrn. Nevertheless, this use may be factitious leading to serious misdiagnosis and pitfalls. Exegesis. - We report two cases of 29 and 60 years old hale patients, referred for hypercorticisin with patent features including metabolic and tropPhical signs. Laboratories findings revealed tinelevated urinary cortisol values (40 and 27 mu g/day) in both cases with normal ACTH and normal plasmatic cortisol response to synacthene (32,5 and 35 mu g/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. Conclusion. - 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. (c) 2005 Elsevier SAS. Tous droits reserves.