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Renal failure obfuscates the diagnosis of Cushing's disease.

THE DIAGNOSIS of Cushing's syndrome can be challenging in the patient with chronic renal failure (RF). Spurious overestimation of plasma cortisol, 1 abnormal cortisol binding, 2,3 poor gastrointestinal tract absorption of dexamethasone, 4 and abnormal response to dexamethasone 5 have all been reported to occur in this setting. The hypophyseal-pituitary-adrenal axis appears to be altered in RF, even in patients who lack overt features of Cushing's syndrome, although diurnal variation of plasma cortisol is usually preserved. 5 While much attention has been focused on the laboratory abnormalities in RF patients, little has been published about the occasional RF patient with clinical manifestations of hypercortisolism. The usual diagnostic criteria, standardized for patients with normal renal function, may not be adequate to make the diagnosis. Report of a Case A 43-year-old man had a history of type II diabetes mellitus of eight years' duration, hypertension, congestive heart failure, hypertriglyceridemia, and chronic RF