The Differential Diagnosis between Pseudo Cushing's Syndrome and True Cushing's Syndrome in a Septic Patient in the Pre-Agonal Phase: A Case Report

Introduction: Sepsis is an illness characterized by a high-stress condition for patients, accompanied by alterations in biochemical processes, behavior, and levels of consciousness. Hormonal alterations that can be seen in this context include increased plasma cortisol values, a condition known as pseudo-Cushing's syndrome (PCS), which in exceptional cases requires a differential diagnosis from true Cushing's syndrome (CS). Case presentation: We report a septic patient with pseudo-Cushing's syndrome in the pre-agonal phase, suggesting that PCS during sepsis is an underestimated condition, as the severity of the patient's clinical condition is compounded by the difficulty of diagnosis itself. Conclusion: In this clinical case, for the severe clinical conditions of the patient and the poor prognosis, we conducted a comprehensive endocrine work-up to rule out an ACTH-dependent hypercortisolism that, if confirmed, could have changed the therapeutic approach and the prognosis of the reported patient.