True or Pseudo-Cushing's Syndrome

• Pseudo-Cushing's syndrome can be caused by alcohol abuse, severe depression, eating disorders, and chronic illness.
• It presents with similar clinical and biochemical features as true Cushing's syndrome.
• The insulin tolerance test (ITT) can differentiate between true and pseudo-Cushing's states.
• ITT involves administering intravenous insulin to induce hypoglycemia and stimulate cortisol release.
• In true Cushing's syndrome, there will be a blunted or absent cortisol response due to excess cortisol feedback on the HPA axis.
• In pseudo-Cushing's states, the HPA axis can respond to stress, and the ITT would generally show an appropriate cortisol response.
• ITT is not a first-line diagnostic test for Cushing's syndrome due to potential risks.
• Alternative tests, such as dexamethasone suppression test, urinary free cortisol, or salivary cortisol measurements, are performed before considering ITT.
• ITT is reserved for cases where other tests are inconclusive.
• Differentiating true and pseudo-Cushing's states is important for appropriate treatment.

Think you know the differences between true and pseudo-Cushing's syndrome? Test your knowledge with this quiz! Learn about the various causes and clinical features of pseudo-Cushing's, as well as the insulin tolerance test (ITT) used to differentiate it from true Cushing's. Discover why ITT is not a first-line diagnostic test and what alternative tests are used. With this quiz, you'll gain a better understanding of the importance of distinguishing between true and pseudo-Cushing's for effective treatment.