Co-Occurrence of Endogenous and Exogenous Cushing's Syndromes: Does "Double Cushing Syndrome" Really Exist? A Case Report

Abstract

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.