The pseudo-Cushing's syndrome in a septic patient

What is it about?

The sepsis is an illness characterized from a high stress condition for patients, with biochemical, behavioural and state of consciousness changes. Hormonal alterations that can be seen in this context include increased plasma cortisol values, a condition known as pseudo-Cushing's syndrome (PCS), which in exceptional cases required a differential diagnosis from true Cushing's syndrome (CS). We report a septic patient with pseudo-Cushing's syndrome in the pre-agonal phase, suggesting that PCS during sepsis is an underestimated condition, as the severity of the patient's clinical condition is compounded by the difficulty of diagnosis itself. In this clinical case, for the severe clinical conditions of the patient and the poor prognosis, we conducted a comprehensive endocrine work-up to rule out an ACTH-dependent hypercortisolism that, if confirmed, could have changed the therapeutic approach and the prognosis of the reported patient.

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Why is it important?

Our clinical case describes a septic patient with pseudo-Cushing's syndrome in the pre-agonal phase, suggesting that PCS during sepsis is an underestimated condition, as the severity of the patient's clinical condition is compounded by the difficulty of diagnosis itself. The differential diagnosis between PCS and CS in critical illness like sepsis and septic shock may have a clinical significance in patients with diagnosis in doubt, for whom a certain diagnosis is expected to change the therapeutic approach and the prognosis, for example, with a view to starting supportive therapy in an already critical patient.

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