Alcohol-induced Cushingoid syndrome.

Although it has been known for some time that alcohol affects the hypothalamic-pituitary-adrenal axis, the clinical significance of this disturbance has only recently become recognised. Over the last 5 years, 27 cases of an apparent Cushing's syndrome have been documented, usually resolving within weeks of alcohol withdrawal. Differentiation from the true Cushing's syndrome can be difficult before resolution, which may be prolonged for several months, but an insulin stress test can be useful in their distinction. The syndrome is invariably pituitary dependent but may not be a specific drug effect of ethanol but rather a consequence of the chronic stress of alcoholism.