We read the article by Boscaro et al1 with keen interest. Given the fact that Cushing syndrome remains a clinical entity for which many people are screened simply because of uncertainty arising from unusual presentations and limitations of current diagnostic tests, we wish to extend the list of atypical presentations provided in this elegant review.
In a recently published brief report, Lacroix et al2 reported an unusual case of 63-year-old woman who developed Cushing syndrome as the result of expression of aberrant adrenocortical receptors responsive to luteinizing hormone, chorionic gonadotropin (with its leuteinizing hormone–like activity), and drugs activating serotonin (5-hydroxytryptamine) receptors (cisapride, metoclopramide). The patient had macronodular adrenal hyperplasia. Long-term treatment with leuprolide acetate led to complete reversal of the syndrome.
Khardori R. Considerations in Diagnosis of Cushing Syndrome. Arch Intern Med. 2001;161(14):1780. doi: