Minanni Carlos André, De Almeida Cardoso Ana Luiza, de Albuquerque Albuquerque Edoarda Vasco, Brito Luciana Pinto, Lopes Ludmilla Malveira Lima, Glezer Andrea, Verduguez Elisa Del Rosario Ugarte, De Mendonça Berenice Bilharinho, Bronstein Marcello Delano, Machado Marcio Carlos, Fragoso Maria Candida Barisson Villares
Neuroendocrinology Unit, São Paulo, Brazil.
Laboratory of Hormones and Molecular Genetics - LIM/42, São Paulo, Brazil.
Clin Diabetes Endocrinol. 2015 Jun 4;1:3. doi: 10.1186/s40842-015-0002-8. eCollection 2015.
Münchhausen's syndrome (MS) is a chronic factitious disorder characterized by the intentional production of clinical symptoms without external incentive. One type of MS is factitious Cushing syndrome, an extremely rare clinical situation in which the diagnosis is challenging mainly due to interference of the exogenous medication in cortisol immunoassays. We described a 26-year-old woman who was originally diagnosed with a macroprolactinoma and during follow-up developed clinical and laboratorial hypercortisolism. A transsphenoidal surgery was performed and immunohistochemistry revealed positive and diffuse staining for both hormones. Four years later, her hypercortisolism recurred and the confirmation of factitious Cushing syndrome was delayed due to conflicting laboratorial results. There are few cases in the literature of factitious Cushing syndrome, and only one had a fatal outcome. The diagnosis of this condition is complex and includes cyclic Cushing syndrome in the differential diagnosis. These patients have high morbidity and increased mortality risk and are likely to have other psychiatric disorders. Prednisone was identified as the culprit in the majority of the cases.
孟乔森综合征（MS）是一种慢性做作性障碍，其特征是在没有外部诱因的情况下故意产生临床症状。MS的一种类型是做作性库欣综合征，这是一种极为罕见的临床情况，其诊断具有挑战性，主要是因为外源性药物干扰了皮质醇免疫测定。我们描述了一名26岁女性，最初被诊断为大泌乳素瘤，在随访期间出现临床和实验室检查的皮质醇增多症。进行了经蝶窦手术，免疫组织化学显示两种激素均呈阳性且弥漫性染色。四年后，她的皮质醇增多症复发，由于实验室检查结果相互矛盾，做作性库欣综合征的确诊被推迟。文献中关于做作性库欣综合征的病例很少，仅有一例导致死亡。这种疾病的诊断很复杂，鉴别诊断包括周期性库欣综合征。这些患者发病率高，死亡风险增加，并且可能患有其他精神障碍。在大多数病例中，泼尼松被确定为罪魁祸首。
