# Co‐Occurrence of Endogenous and Exogenous Cushing's Syndromes: Does “Double Cushing Syndrome” Really Exist? A Case Report

## TL;DR

The paper reports a case where both exogenous and endogenous Cushing's syndromes occurred together, highlighting the importance of proper diagnosis and testing.

## Contribution

The paper confirms the existence of 'Double Cushing Syndrome' and emphasizes the need for specific diagnostic tests to identify concurrent adrenal issues.

## Key findings

- Double Cushing syndrome can occur when exogenous steroids mask adrenal hypercortisolism.
- Persistent high cortisol after stopping steroids suggests an endogenous source.
- Early diagnosis using ACTH testing and imaging improves outcomes and reduces misdiagnosis.

## 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.