Pseudo-Cushing’s Syndrome: A Diagnostic Dilemma

  • Teresa Brown
  • Regina Belokovskaya
  • Rachel Pessah-Pollack


The diagnosis of neoplastic Cushing’s syndrome can be a very challenging undertaking because it can be difficult, though critical, to exclude physiologic or non-neoplastic causes. A thorough history including concurrent medications and medical problems is vital. The most common causes of non-neoplastic physiological hypercortisolism, often referred to as pseudo-Cushing’s syndrome, are alcoholism and alcohol withdrawal, chronic kidney disease, depression or neuropsychiatric disease, pregnancy, uncontrolled diabetes, starvation/malnutrition, chronic intense exercise, and glucocorticoid resistance. Interpretation of diagnostic tests for Cushing’s syndrome requires an assessment for the common causes of non-neoplastic physiological hypercortisolism to prevent a misdiagnosis of Cushing’s syndrome.


Pseudo-Cushing’s Cushing’s syndrome Hypercortisolism Salivary cortisol Urinary free cortisol 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Teresa Brown
    • 1
  • Regina Belokovskaya
    • 1
  • Rachel Pessah-Pollack
    • 1
  1. 1.Icahn School of Medicine at Mount Sinai Medical Center, Division of Endocrinology, Diabetes, & Bone DiseaseNew YorkUSA

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