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We have read with interest the case report of Chiodera et al,¹ which addresses the issue of the differential diagnosis of corticotropin-dependent Cushing syndrome. It provides us a fine example of how challenging this task might be and underscores the merit of continuing clinical and biochemical evaluation in equivocal cases. A second biochemical assessment may draw out more apparent data than the one at baseline, as it occurred in their case. This is an important practical message to be applied whenever patient conditions allow an expectant management.

We have previously reported a case of cyclical Cushing syndrome sustained by an adrenal pheochromocytoma for which only reiterate clinical and biochemical appraisal over time permitted the discovery of the intermittent nature of the ectopic corticotropin secretion and its source.² In the case reported by Chiodera et al,¹ it is likely that the mild hypercortisolism of Cushing disease, with no radiological evidence of . . . [Full Text of this Article]

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