Case report reveals that concurrent endogenous and exogenous Cushing's syndrome may occur, indicating timely ACTH testing and surgery are vital.
Double Cushing syndrome exists: exogenous steroid use can mask concurrent adrenal hypercortisolism. When symptoms persist and cortisol remains high after tapering or stopping prescribed glucocorticoids, an endogenous source is likely. Early recognition with ACTH testing, dexamethasone suppression, and adrenal imaging reduces misdiagnosis, favors timely surgery, and supports safe tapering.
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Amani-Beni et al. (2025) studied this question.
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