Cyclic Cushing's syndrome

Because glucocorticoids are necessary to sustain life and maintain homeostasis, adrenal disorders, if not detected in a timely fashion, can have serious consequences. Cyclic Cushing's syndrome is a disease characterized by rhythmic fluctuations in glucocorticoid production. In patients with this disorder, both clinical and biochemical spontaneous remissions may occur and therefore the activity of the hypothalamic-pituitary-adrenal axis between the cycles may be undisturbed. The clinical manifestation of cyclic Cushing's syndrome may be complex and varied, differing not only between patients but also in the same patient on a daily to monthly basis. The presence of cyclic Cushing's syndrome should always be considered in patients with a clinical presentation of hypercortisolism coexisting with normal glucocorticoid plasma levels and a paradoxical response to the dexamethasone test. We here present a detailed case report on a patient diagnosed with cyclic Cushing's syndrome. We report diagnostic and treatment strategies used in our patient and their impact on the course and outcome of the disease.