Pseudo CS

 Q: All of the following may have some clinical features of Cushing's Syndrome (CS) EXCEPT?

A) Prolong ICU stay  

B) Severe major depressive disorder

C) Poorly controlled diabetes 

D) Glucocorticoid resistance

E) Obstructive sleep apnea

Answer: D

Physiologic hypercortisolism is also called pseudo-CS. They may have some clinical features of CS or may not. 

Conditions with some clinical features of CS include: pregnancy, severe visceral obesity, polycystic ovary syndrome (PCOS), severe major depressive disorder, poorly controlled diabetes mellitus, prolonged illness/hospitalization, and obstructive sleep apnea. 

Physiologic hypercortisolism that are unlikely to have clinical features of CS are anorexia nervosa, intense chronic exercise, hypothalamic amenorrhea, high corticosteroid-binding globulin (CBG) and glucocorticoid resistance.

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References:

1. Lacroix A, Feelders RA, Stratakis CA, Nieman LK. Cushing's syndrome. Lancet 2015; 386:913. 

2.  Arnaldi G, Angeli A, Atkinson AB, et al. Diagnosis and complications of Cushing's syndrome: a consensus statement. J Clin Endocrinol Metab 2003; 88:5593. 

3. Newell-Price J, Trainer P, Besser M, Grossman A. The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states. Endocr Rev 1998; 19:647. 

4. Loosen PT, Chambliss B, DeBold CR, et al. Psychiatric phenomenology in Cushing's disease. Pharmacopsychiatry 1992; 25:192.