Alcohol-induced pseudo-cushing's syndrome mimicking cushing's disease in a patient with an adrenal mass

Abstract

Alcohol-induced pseudo-Cushing's syndrome is a disorder in which patients exhibit clinical and/or biochemical features similar to those in patients with Cushing's syndrome, but these features, related to alcohol abuse, may be transient and resolve during abstinence from alcohol. In most previous reports of alcohol-induced pseudo-Cushing's syndrome, detailed endocrinologic data supporting a diagnosis of Cushing's syndrome have been lacking. This report describes a patient with clinical features of Cushing's syndrome, increased plasma ACTH values, and elevated levels of basal urinary free cortisol and 17-hydroxysteroids that were not suppressed by low-dose dexamethasone but were suppressed by high-dose dexamethasone. Detailed test results were indistinguishable from those in Cushing's disease, which had been the initial diagnosis. When an occult history of alcohol abuse was discovered, the suspicion of alcohol-induced pseudo-Cushing's syndrome was raised. During an extended hospitalization and abstinence from alcohol, abnormal endocrinologic test results gradually became normal. This patient also demonstrated a further complicating feature, a left adrenal mass, which appeared to be a benign, coincidental lesion. Because of the high prevalence of alcohol abuse and the possibility that test results may be identical to those in Cushing's disease, clinicians should be familiar with this disorder to avoid misdiagnosis and inappropriate therapy.