Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/34189
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dc.contributor.authorPark, Yeung-Ae-
dc.contributor.authorGao, Frank-
dc.contributor.authorSim, Ie-Wen-
dc.contributor.authorGilfillan, Chris-
dc.date2023-
dc.date.accessioned2023-11-10T01:46:05Z-
dc.date.available2023-11-10T01:46:05Z-
dc.date.issued2023-07-
dc.identifier.citationJCEM Case Reports 2023-07; 1(4)en_US
dc.identifier.issn2755-1520-
dc.identifier.urihttps://ahro.austin.org.au/austinjspui/handle/1/34189-
dc.description.abstractDistinguishing between Cushing syndrome (CS) and pseudo Cushing syndrome (PCS), also known as physiological hypercortisolism, can be difficult. PCS is caused by nonneoplastic overactivity of the hypothalamic-pituitary-adrenal axis and may be secondary to a range of conditions, including obesity, physical stress, malnutrition, and chronic alcoholism, and typically results in a lesser degree of hypercortisolism and fewer clinical features than CS. Management of PCS includes treatment of the underlying cause and reassessment of hypercortisolemia following improvement in the underlying etiology, as this may result in normalization of cortisol levels. The role of adrenal enzyme inhibitors in lowering cortisol levels in those with PCS is poorly understood. We report a case of a man presenting with weight loss who was found to have severe hypercortisolemia and elevated adrenocorticotropin (ACTH) complicated by infection, neuropsychiatric disturbance, and hypokalemia. Despite high cortisol levels, he was phenotypically not cushingoid, and the circadian rhythm of cortisol was preserved. Extensive investigations did not demonstrate a cause of symptoms or source of ACTH. Medical management with ketoconazole improved neuropsychiatric symptoms, and weight gain with nasogastric feeds resulted in the normalization of cortisol levels and resolution of symptoms following ketoconazole cessation.en_US
dc.language.isoeng-
dc.subjectCushing syndromeen_US
dc.subjecthypercortisolismen_US
dc.subjectmalnutritionen_US
dc.subjectnonneoplastic hypercortisolismen_US
dc.subjectpseudo-Cushing syndromeen_US
dc.titlePseudo-Cushing Syndrome With an Atypically High Cortisol Burden and Clinical Improvement With Adrenal Enzyme Inhibitor.en_US
dc.typeJournal Articleen_US
dc.identifier.journaltitleJCEM Case Reportsen_US
dc.identifier.affiliationDepartment of Endocrinology and Diabetes, Eastern Health, Box Hill, Victoria 3128, Australia.;Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.en_US
dc.identifier.affiliationMedicine (University of Melbourne)en_US
dc.identifier.affiliationMelbourne Medical School, University of Melbourne, Parkville, Victoria 3010, Australia.en_US
dc.identifier.affiliationDepartment of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3800, Australia.en_US
dc.identifier.doi10.1210/jcemcr/luad075en_US
dc.type.contentTexten_US
dc.identifier.orcid0000-0003-4632-9306en_US
dc.identifier.pubmedid37909002-
dc.description.volume1-
dc.description.issue4-
dc.description.startpageluad075-
item.languageiso639-1en-
item.fulltextNo Fulltext-
item.grantfulltextnone-
item.cerifentitytypePublications-
item.openairetypeJournal Article-
item.openairecristypehttp://purl.org/coar/resource_type/c_18cf-
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