Pseudo-Cushing syndrome is hypercortisolism secondary to an underlying illness, as opposed to the exogenous or ectopic cortisol exposure that causes Cushing syndrome. Patients with pseudo-Cushing syndrome present with the same symptoms as Cushing syndrome: lipodystrophy, moon facies, abdominal striae, bruising, hirsutism, lethargy, weight gain, abnormal menses, osteopenia or fracture, and proximal muscle weakness. However, the patient will not have a history of glucocorticoid use or the presence of a tumor that is ectopically secreting cortisol, adrenocorticotropic hormone (ACTH), or corticotropin-releasing hormone (CRH). Rather than this ectopic or exogenous hypercortisolism, pseudo-Cushing syndrome is caused by overactivation of the normal hypothalamic-pituitary-adrenal axis.

Common causes of pseudo-Cushing syndrome include pregnancy, alcohol use disorder, morbid obesity, polycystic ovarian syndrome, end-stage renal disease, severe major depressive disorder, and poorly controlled diabetes. Treatment of the underlying illness will resolve the pseudo-Cushing syndrome.