Departments of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States.
Department of Medicine. Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States.
Front Endocrinol (Lausanne). 2023 Jun 20;14:1199091. doi: 10.3389/fendo.2023.1199091. eCollection 2023.
Alcohol-induced hypercortisolism (AIH) is underrecognized and may masquerade as neoplastic hypercortisolism [Cushing syndrome (CS)] obscuring its diagnosis.
In order to characterize AIH, we performed a chart review of eight patients (4 males and 4 females; 2014-2022) referred for evaluation and treatment of neoplastic hypercortisolism - six for inferior petrosal sinus sampling, one due to persistent CS after unilateral adrenalectomy, and one for pituitary surgery for Cushing disease (CD). Five underwent dDAVP stimulation testing.
All eight patients had clinical features of hypercortisolism and plasma ACTH levels within or above the reference interval confirming hypothalamic-pituitary mediation. All had abnormal low-dose dexamethasone suppression test and increased late-night salivary cortisol. Only one had increased urine cortisol excretion. In contrast to CD, the 5 patients tested had blunted or absent ACTH and cortisol responses to desmopressin. Two had adrenal nodules and one had abnormal pituitary imaging. Most patients underreported their alcohol consumption and one denied alcohol use. Elevated blood phosphatidyl ethanol (PEth) was required in one patient to confirm excessive alcohol use. All patients had elevations of liver function tests (LFTs) with AST>ALT.
AIH is an under-appreciated, reversible cause of non-neoplastic hypercortisolism that is indistinguishable from neoplastic CS. Incidental pituitary and adrenal imaging abnormalities as well as under-reporting of alcohol consumption further confound the diagnosis. Measurement of PEth helps to confirm an alcohol use disorder. Elevations of LFTs (AST>ALT) and subnormal ACTH and cortisol responses to dDAVP help to distinguish AIH from neoplastic hypercortisolism.
酒精性皮质醇增多症（AIH）认识不足，可能表现为肿瘤性皮质醇增多症[库欣综合征（CS）]，掩盖其诊断。
为了明确 AIH 的特征，我们对 8 例（4 男 4 女；2014-2022 年）因肿瘤性皮质醇增多症评估和治疗而转诊的患者进行了病历回顾，6 例行蝶鞍岩下窦采样，1 例单侧肾上腺切除术后持续 CS，1 例因库欣病（CD）行垂体手术。5 例行 dDAVP 刺激试验。
8 例患者均有皮质醇增多症的临床特征，且血浆 ACTH 水平处于或高于参考区间，证实了下丘脑-垂体的调节。所有患者均有异常的小剂量地塞米松抑制试验和夜间唾液皮质醇升高。仅 1 例尿皮质醇排泄增加。与 CD 不同，5 例接受检测的患者的 ACTH 和皮质醇对去氨加压素的反应减弱或消失。2 例患者有肾上腺结节，1 例患者有异常的垂体影像学改变。大多数患者对饮酒的报告不足，1 例否认饮酒。1 例患者需要检测血磷脂酰乙醇（PEth）以确认过量饮酒。所有患者的肝功能试验（LFTs）均升高，AST＞ALT。
AIH 是一种被低估的、可逆转的非肿瘤性皮质醇增多症病因，与肿瘤性 CS 无法区分。偶然的垂体和肾上腺影像学异常以及对饮酒的报告不足进一步混淆了诊断。PEth 的测量有助于确认酒精使用障碍。升高的 LFTs（AST＞ALT）和 dDAVP 刺激试验中 ACTH 和皮质醇反应低下有助于将 AIH 与肿瘤性皮质醇增多症区分开来。
