WASHINGTON-Dr. Cushing, have you met Dr. Munchausen?
An NIH team reviewing 860 patients with hypercortisolism over 15 years found six whose puzzling lab and clinical features after getting glucocorticoids suggested Munchausen’s.
The tip-off for factitious Cushing’s was a rapid alternation from extremely low to high levels of urine free cortisol and 17-hydroxysteroids, Dr. Giovanni Cizza told the combined clinical research societies meeting here.
All six also had multiple operations unrelated to Cushing’s, and each had a history of depression or anxiety. Three had a drug-use history, and three had undergone surgery for Cushing’s. All were in their 30s or 40s.
Dr. Cizza said that demonstration of atrophic adrenals should alert clinicians to the possibility of factitious Cushing’s.
