Pseudo-Cushing syndrome mimics Cushing’s syndrome. It is a group of conditions and have different causes. In both the syndrome, patients may feel increased levels of cortisol hormone and have same symptoms. Pseudo-Cushing syndrome (PCS) is caused by problems in stress response system of body.
Epidemiology
Psychological stress: Diseases like anxiety, depression, and PTSD are the factors which can cause PCS. Studies have seen that elevated levels of cortisol have been seen in 50% of the patients who have depression.
Medical conditions: Sleep apnea, obesity, chronic pain, and eating diseases may increase levels of cortisol.
Medications: Glucocorticoids and psychiatric drugs can increase the levels of cortisol and mimic the Cushing’s syndrome. This can lead to complications in diagnosis and epidemiology.
Alcohol abuse: Consumption of alcohol can disrupt the HPA axis. This can cause an elevated levels of cortisol and develop PCS.
Anatomy
Pathophysiology
Alcoholism: Chronic alcohol misuse may lead to active the HPA axis and elevation the level of cortisol and an appearance of cushingoid. Ethanol can affect the adrenal glands and cause alterations in metabolism of cortisol.
Severe depression or stress: Severe depression or stress can activate HPA axis and lead to elevated effects of cortisol. This activation can mimic the symptoms of Cushing’s syndrome and does not increase the production of cortisol.
Obesity: Adipose tissue can produce elevated levels of cortisol in obese people and, change the activity of metabolism of cortisol and lead to elevated effects of cortisol.
Chronic inflammation or illness: Chronic inflammatory diseases may stimulate the HPA axis and lead to increased effects of cortisol.
Etiology
Obesity: Adipose tissue, like visceral fat, produces CRH and other factors that can secrete cortisol. Insulin resistance, which is linked with obesity, may release more cortisol.
Sleep apnea: Obstructive sleep apnea leads to shallow breathing and lead to hypoxia and activation of HPA axis which can increase the cortisol and restore the levels of oxygen.
Chronic pain: Chronic pain diseases may cause CRH release and increases cortisol to control the pain perception.
Eating disorders: Hormonal imbalances, starvation, stress, anorexia nervosa, and bulimia nervosa are associated with increased levels of cortisol and changes the HPA axis.
Genetics
Prognostic Factors
Psychological Factors: Psychological factors like stress, anxiety, sadness may cause PCS.
Medication Management: If PCS is caused by corticosteroid medications, proper management and care under medical supervision can improve the prognosis of the disease.
Clinical History
Age group: There is no particular age group in which PCS occurs. It can cause in different ages or different causes which can trigger the hypercortisolism like symptoms.
Physical Examination
Weight Gain and Obesity: Central obesity is seen in PCS. It is a condition in which accumulation of fat around the upper back and abdomen.
Facial Features: Check for a rounded face with appearance of plethoric a moon face. It may be look like flushed or red cheeks.
Hirsutism: Check for excess hair growth in women, specifically on the chest, face, and abdomen.
Skin Changes: Check for any acne on skin, skin lesions, or skin tags.
Blood Pressure: Check blood pressure (hypertension) is linked with Cushing’s syndrome.
Age group
Associated comorbidity
Chronic Alcoholism: Any change in metabolism of cortisol is a result of chronic use of alcohol. It mimics the symptoms of Cushing’s syndrome. It develops to PCS.
Severe Obesity: People who have severe obesity may have same symptoms of Cushing syndrome because of increased adipose tissue, changes in cortisol metabolism, and imbalances in hormones.
Polycystic Ovary Syndrome: PCOS is a hormonal disease in women. It can include an increased levels of androgen. Some symptoms of PCOS, like weight gain, irregular periods, and hirsutism, might be associated with Cushing’s syndrome.
Chronic Stress or Chronic Illness: Long-term stress and chronic diseases like poorly controlled diabetes, severe infections, or chronic pain diseases can lead to changes in levels of cortisol and cause symptoms of Cushing’s syndrome.
Certain Medications: PCS can be caused by medications like corticosteroids, which may cause symptoms of Cushing’s syndrome when it is used in increased doses or for prolonged periods.
Associated activity
Acuity of presentation
Weight Gain: Patients may experience rapid weight gain, specifically in the abdomen, face, and trunk, which can lead to moon face appearance and central obesity. Weight gain is not more than the actual Cushing’s syndrome.
Hypertension:High blood pressure may be present because of different mechanisms like cortisol-like effects or imbalance in hormones.
Glucose Intolerance: Some people nay develop impaired glucose tolerance or diabetes because of changes in sensitivity of insulin which is caused by increased effects of cortisol.
Psychiatric Symptoms: Irritability, depression, mood swings, and cognitive changes may be present.
Fatigue and Weakness: Patients may feel muscle weakness, fatigue, and generalized malaise.
Easy Bruising and Thinning of the Skin: Changes in the skin, like easy bruising, thinning, and striae, may occur.
Osteoporosis: Bone density loss and an elevated risk of fractures may be seen because of the excess cortisol-like substance on the metabolism of bone.
Differential Diagnoses
Depression: Exhaustion, weight gain, anxiety, sadness and mood swings are psychological diseases can mimic the symptoms of Cushing’s disease.
Alcoholism: Chronic alcohol abuse can lead to central obesity, muscle weakness, hypertension, and mood changes are similar effects of Cushing’s syndrome.
Obesity: Individuals who have severe obesity may have same physical features like central adiposity, muscle weakness, and thin skin which can be taken as a symptoms of Cushing’s syndrome.
Polycystic Ovary Syndrome: Women who have PCOS can have signs like hirsutism, weight gain, irregular menstrual cycles, and resistance to insulin may be confused with the symptoms of Cushing’s syndrome.
Metabolic Syndrome: Symptoms of Cushing’s syndrome may be present in diseases like resistance to insulin, hypertension, central obesity, and dyslipidemia.
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Diagnosis of the disease is important. The tests which may be included to measure the free cortisol in 24 hours urine collections are late night salivary cortisol test, dexamethasone suppression test.
Evaluate the medications which is taking by patients that may cause PCS. If it is happening, alter or discontinue the medication under the guidance of healthcare providers.
Use techniques which can reduce the stress like counselling, therapy, or stress management courses. Treat any underlying disease like alcoholism, depression, or obesity with proper therapy, counseling, or modifications in lifestyle.
Evaluate the cortisol level, perform any relevant diagnostic test on a periodic basis to make sure that the disease is not progressive, and cortisol level is return to normal.
Lifestyle Modifications: Include a balanced diet and exercise. Get proper sleep for good health. Stress reduction techniques like mediation. Yoga, mindfulness may help o control the stress levels.
Psychological Support: Psychological support and care may be helpful to manage the diseases like chronic stress or depression.
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lifestyle-modifications-to-treat-pcs
Healthy Lifestyle Changes: Include a healthy lifestyle like a balanced diet and regular exercise. Weight management is important.
Medication Review: Review the medications which is taken by patients like corticosteroids can cause symptoms of PCS. Adjust or change these medications.
Psychological Support: Give psychological support and counseling if depression, stress, or anxiety are contributing factors. Cognitive behavioral therapy will also help.
Monitor Health: DO regular check-ups and monitor the symptoms are necessary. This can help to track the progress of disease and if the treatment is effective or not.
Avoidance of Alcohol and Other Triggers: Treat alcohol abuse disease or other substances for proper treatment.
Educational Support: Educate people about the condition and how to manage it.
Collaboration with Healthcare Professionals: Collaborate with medical professionals like psychologists, nutritionists, and endocrinologists to develop treatment plans.
role-of-antidepressants-to-treat-pcs
Selective Serotonin Reuptake Inhibitors (SSRIs):
Sertraline and fluoxetine: It is used to treat anxiety and depression. It is linked with PCS. These medications help to reduce the symptoms of depression and stress related activation of HPA axis.
role-of-management-to-treat-pcs
Diagnosis and Identification of Underlying Cause: This includes a medical history, physical examination, and different tests like urinary free cortisol, low dose dexamethasone suppression test, late night salivary cortisol.
Identification and Treatment of Underlying Conditions: PCS may be caused by different diseases like depression, obesity, alcoholism, PCOS. Manage these disease include multidisciplinary approaches with psychiatry, endocrinology, gynecologist. Treatment may need medications, lifestyle medications or therapy.
Medication Adjustment or Withdrawal: Medications like corticosteroids are known to mimic PCS. Continuously manage the medications on regular basis to avoid adverse effects.
Monitoring and Follow-up: Take follow up tests to monitor the cortisol level and check the symptoms as recommended by healthcare providers.
Long-Term Management: Continue monitor and manage the underlying conditions is necessary to control the disease for long term.
Pseudo-Cushing syndrome mimics Cushing’s syndrome. It is a group of conditions and have different causes. In both the syndrome, patients may feel increased levels of cortisol hormone and have same symptoms. Pseudo-Cushing syndrome (PCS) is caused by problems in stress response system of body.
Psychological stress: Diseases like anxiety, depression, and PTSD are the factors which can cause PCS. Studies have seen that elevated levels of cortisol have been seen in 50% of the patients who have depression.
Medical conditions: Sleep apnea, obesity, chronic pain, and eating diseases may increase levels of cortisol.
Medications: Glucocorticoids and psychiatric drugs can increase the levels of cortisol and mimic the Cushing’s syndrome. This can lead to complications in diagnosis and epidemiology.
Alcohol abuse: Consumption of alcohol can disrupt the HPA axis. This can cause an elevated levels of cortisol and develop PCS.
Alcoholism: Chronic alcohol misuse may lead to active the HPA axis and elevation the level of cortisol and an appearance of cushingoid. Ethanol can affect the adrenal glands and cause alterations in metabolism of cortisol.
Severe depression or stress: Severe depression or stress can activate HPA axis and lead to elevated effects of cortisol. This activation can mimic the symptoms of Cushing’s syndrome and does not increase the production of cortisol.
Obesity: Adipose tissue can produce elevated levels of cortisol in obese people and, change the activity of metabolism of cortisol and lead to elevated effects of cortisol.
Chronic inflammation or illness: Chronic inflammatory diseases may stimulate the HPA axis and lead to increased effects of cortisol.
Obesity: Adipose tissue, like visceral fat, produces CRH and other factors that can secrete cortisol. Insulin resistance, which is linked with obesity, may release more cortisol.
Sleep apnea: Obstructive sleep apnea leads to shallow breathing and lead to hypoxia and activation of HPA axis which can increase the cortisol and restore the levels of oxygen.
Chronic pain: Chronic pain diseases may cause CRH release and increases cortisol to control the pain perception.
Eating disorders: Hormonal imbalances, starvation, stress, anorexia nervosa, and bulimia nervosa are associated with increased levels of cortisol and changes the HPA axis.
Psychological Factors: Psychological factors like stress, anxiety, sadness may cause PCS.
Medication Management: If PCS is caused by corticosteroid medications, proper management and care under medical supervision can improve the prognosis of the disease.
Age group: There is no particular age group in which PCS occurs. It can cause in different ages or different causes which can trigger the hypercortisolism like symptoms.
Weight Gain and Obesity: Central obesity is seen in PCS. It is a condition in which accumulation of fat around the upper back and abdomen.
Facial Features: Check for a rounded face with appearance of plethoric a moon face. It may be look like flushed or red cheeks.
Hirsutism: Check for excess hair growth in women, specifically on the chest, face, and abdomen.
Skin Changes: Check for any acne on skin, skin lesions, or skin tags.
Blood Pressure: Check blood pressure (hypertension) is linked with Cushing’s syndrome.
Chronic Alcoholism: Any change in metabolism of cortisol is a result of chronic use of alcohol. It mimics the symptoms of Cushing’s syndrome. It develops to PCS.
Severe Obesity: People who have severe obesity may have same symptoms of Cushing syndrome because of increased adipose tissue, changes in cortisol metabolism, and imbalances in hormones.
Polycystic Ovary Syndrome: PCOS is a hormonal disease in women. It can include an increased levels of androgen. Some symptoms of PCOS, like weight gain, irregular periods, and hirsutism, might be associated with Cushing’s syndrome.
Chronic Stress or Chronic Illness: Long-term stress and chronic diseases like poorly controlled diabetes, severe infections, or chronic pain diseases can lead to changes in levels of cortisol and cause symptoms of Cushing’s syndrome.
Certain Medications: PCS can be caused by medications like corticosteroids, which may cause symptoms of Cushing’s syndrome when it is used in increased doses or for prolonged periods.
Weight Gain: Patients may experience rapid weight gain, specifically in the abdomen, face, and trunk, which can lead to moon face appearance and central obesity. Weight gain is not more than the actual Cushing’s syndrome.
Hypertension:High blood pressure may be present because of different mechanisms like cortisol-like effects or imbalance in hormones.
Glucose Intolerance: Some people nay develop impaired glucose tolerance or diabetes because of changes in sensitivity of insulin which is caused by increased effects of cortisol.
Psychiatric Symptoms: Irritability, depression, mood swings, and cognitive changes may be present.
Fatigue and Weakness: Patients may feel muscle weakness, fatigue, and generalized malaise.
Easy Bruising and Thinning of the Skin: Changes in the skin, like easy bruising, thinning, and striae, may occur.
Osteoporosis: Bone density loss and an elevated risk of fractures may be seen because of the excess cortisol-like substance on the metabolism of bone.
Depression: Exhaustion, weight gain, anxiety, sadness and mood swings are psychological diseases can mimic the symptoms of Cushing’s disease.
Alcoholism: Chronic alcohol abuse can lead to central obesity, muscle weakness, hypertension, and mood changes are similar effects of Cushing’s syndrome.
Obesity: Individuals who have severe obesity may have same physical features like central adiposity, muscle weakness, and thin skin which can be taken as a symptoms of Cushing’s syndrome.
Polycystic Ovary Syndrome: Women who have PCOS can have signs like hirsutism, weight gain, irregular menstrual cycles, and resistance to insulin may be confused with the symptoms of Cushing’s syndrome.
Metabolic Syndrome: Symptoms of Cushing’s syndrome may be present in diseases like resistance to insulin, hypertension, central obesity, and dyslipidemia.
Diagnosis of the disease is important. The tests which may be included to measure the free cortisol in 24 hours urine collections are late night salivary cortisol test, dexamethasone suppression test.
Evaluate the medications which is taking by patients that may cause PCS. If it is happening, alter or discontinue the medication under the guidance of healthcare providers.
Use techniques which can reduce the stress like counselling, therapy, or stress management courses. Treat any underlying disease like alcoholism, depression, or obesity with proper therapy, counseling, or modifications in lifestyle.
Evaluate the cortisol level, perform any relevant diagnostic test on a periodic basis to make sure that the disease is not progressive, and cortisol level is return to normal.
Lifestyle Modifications: Include a balanced diet and exercise. Get proper sleep for good health. Stress reduction techniques like mediation. Yoga, mindfulness may help o control the stress levels.
Psychological Support: Psychological support and care may be helpful to manage the diseases like chronic stress or depression.
Endocrinology, Metabolism
Healthy Lifestyle Changes: Include a healthy lifestyle like a balanced diet and regular exercise. Weight management is important.
Medication Review: Review the medications which is taken by patients like corticosteroids can cause symptoms of PCS. Adjust or change these medications.
Psychological Support: Give psychological support and counseling if depression, stress, or anxiety are contributing factors. Cognitive behavioral therapy will also help.
Monitor Health: DO regular check-ups and monitor the symptoms are necessary. This can help to track the progress of disease and if the treatment is effective or not.
Avoidance of Alcohol and Other Triggers: Treat alcohol abuse disease or other substances for proper treatment.
Educational Support: Educate people about the condition and how to manage it.
Collaboration with Healthcare Professionals: Collaborate with medical professionals like psychologists, nutritionists, and endocrinologists to develop treatment plans.
Endocrinology, Reproductive/Infertility
Selective Serotonin Reuptake Inhibitors (SSRIs):
Sertraline and fluoxetine: It is used to treat anxiety and depression. It is linked with PCS. These medications help to reduce the symptoms of depression and stress related activation of HPA axis.
Endocrinology, Reproductive/Infertility
Diagnosis and Identification of Underlying Cause: This includes a medical history, physical examination, and different tests like urinary free cortisol, low dose dexamethasone suppression test, late night salivary cortisol.
Identification and Treatment of Underlying Conditions: PCS may be caused by different diseases like depression, obesity, alcoholism, PCOS. Manage these disease include multidisciplinary approaches with psychiatry, endocrinology, gynecologist. Treatment may need medications, lifestyle medications or therapy.
Medication Adjustment or Withdrawal: Medications like corticosteroids are known to mimic PCS. Continuously manage the medications on regular basis to avoid adverse effects.
Monitoring and Follow-up: Take follow up tests to monitor the cortisol level and check the symptoms as recommended by healthcare providers.
Long-Term Management: Continue monitor and manage the underlying conditions is necessary to control the disease for long term.
Pseudo-Cushing syndrome mimics Cushing’s syndrome. It is a group of conditions and have different causes. In both the syndrome, patients may feel increased levels of cortisol hormone and have same symptoms. Pseudo-Cushing syndrome (PCS) is caused by problems in stress response system of body.
Psychological stress: Diseases like anxiety, depression, and PTSD are the factors which can cause PCS. Studies have seen that elevated levels of cortisol have been seen in 50% of the patients who have depression.
Medical conditions: Sleep apnea, obesity, chronic pain, and eating diseases may increase levels of cortisol.
Medications: Glucocorticoids and psychiatric drugs can increase the levels of cortisol and mimic the Cushing’s syndrome. This can lead to complications in diagnosis and epidemiology.
Alcohol abuse: Consumption of alcohol can disrupt the HPA axis. This can cause an elevated levels of cortisol and develop PCS.
Alcoholism: Chronic alcohol misuse may lead to active the HPA axis and elevation the level of cortisol and an appearance of cushingoid. Ethanol can affect the adrenal glands and cause alterations in metabolism of cortisol.
Severe depression or stress: Severe depression or stress can activate HPA axis and lead to elevated effects of cortisol. This activation can mimic the symptoms of Cushing’s syndrome and does not increase the production of cortisol.
Obesity: Adipose tissue can produce elevated levels of cortisol in obese people and, change the activity of metabolism of cortisol and lead to elevated effects of cortisol.
Chronic inflammation or illness: Chronic inflammatory diseases may stimulate the HPA axis and lead to increased effects of cortisol.
Obesity: Adipose tissue, like visceral fat, produces CRH and other factors that can secrete cortisol. Insulin resistance, which is linked with obesity, may release more cortisol.
Sleep apnea: Obstructive sleep apnea leads to shallow breathing and lead to hypoxia and activation of HPA axis which can increase the cortisol and restore the levels of oxygen.
Chronic pain: Chronic pain diseases may cause CRH release and increases cortisol to control the pain perception.
Eating disorders: Hormonal imbalances, starvation, stress, anorexia nervosa, and bulimia nervosa are associated with increased levels of cortisol and changes the HPA axis.
Psychological Factors: Psychological factors like stress, anxiety, sadness may cause PCS.
Medication Management: If PCS is caused by corticosteroid medications, proper management and care under medical supervision can improve the prognosis of the disease.
Age group: There is no particular age group in which PCS occurs. It can cause in different ages or different causes which can trigger the hypercortisolism like symptoms.
Weight Gain and Obesity: Central obesity is seen in PCS. It is a condition in which accumulation of fat around the upper back and abdomen.
Facial Features: Check for a rounded face with appearance of plethoric a moon face. It may be look like flushed or red cheeks.
Hirsutism: Check for excess hair growth in women, specifically on the chest, face, and abdomen.
Skin Changes: Check for any acne on skin, skin lesions, or skin tags.
Blood Pressure: Check blood pressure (hypertension) is linked with Cushing’s syndrome.
Chronic Alcoholism: Any change in metabolism of cortisol is a result of chronic use of alcohol. It mimics the symptoms of Cushing’s syndrome. It develops to PCS.
Severe Obesity: People who have severe obesity may have same symptoms of Cushing syndrome because of increased adipose tissue, changes in cortisol metabolism, and imbalances in hormones.
Polycystic Ovary Syndrome: PCOS is a hormonal disease in women. It can include an increased levels of androgen. Some symptoms of PCOS, like weight gain, irregular periods, and hirsutism, might be associated with Cushing’s syndrome.
Chronic Stress or Chronic Illness: Long-term stress and chronic diseases like poorly controlled diabetes, severe infections, or chronic pain diseases can lead to changes in levels of cortisol and cause symptoms of Cushing’s syndrome.
Certain Medications: PCS can be caused by medications like corticosteroids, which may cause symptoms of Cushing’s syndrome when it is used in increased doses or for prolonged periods.
Weight Gain: Patients may experience rapid weight gain, specifically in the abdomen, face, and trunk, which can lead to moon face appearance and central obesity. Weight gain is not more than the actual Cushing’s syndrome.
Hypertension:High blood pressure may be present because of different mechanisms like cortisol-like effects or imbalance in hormones.
Glucose Intolerance: Some people nay develop impaired glucose tolerance or diabetes because of changes in sensitivity of insulin which is caused by increased effects of cortisol.
Psychiatric Symptoms: Irritability, depression, mood swings, and cognitive changes may be present.
Fatigue and Weakness: Patients may feel muscle weakness, fatigue, and generalized malaise.
Easy Bruising and Thinning of the Skin: Changes in the skin, like easy bruising, thinning, and striae, may occur.
Osteoporosis: Bone density loss and an elevated risk of fractures may be seen because of the excess cortisol-like substance on the metabolism of bone.
Depression: Exhaustion, weight gain, anxiety, sadness and mood swings are psychological diseases can mimic the symptoms of Cushing’s disease.
Alcoholism: Chronic alcohol abuse can lead to central obesity, muscle weakness, hypertension, and mood changes are similar effects of Cushing’s syndrome.
Obesity: Individuals who have severe obesity may have same physical features like central adiposity, muscle weakness, and thin skin which can be taken as a symptoms of Cushing’s syndrome.
Polycystic Ovary Syndrome: Women who have PCOS can have signs like hirsutism, weight gain, irregular menstrual cycles, and resistance to insulin may be confused with the symptoms of Cushing’s syndrome.
Metabolic Syndrome: Symptoms of Cushing’s syndrome may be present in diseases like resistance to insulin, hypertension, central obesity, and dyslipidemia.
Diagnosis of the disease is important. The tests which may be included to measure the free cortisol in 24 hours urine collections are late night salivary cortisol test, dexamethasone suppression test.
Evaluate the medications which is taking by patients that may cause PCS. If it is happening, alter or discontinue the medication under the guidance of healthcare providers.
Use techniques which can reduce the stress like counselling, therapy, or stress management courses. Treat any underlying disease like alcoholism, depression, or obesity with proper therapy, counseling, or modifications in lifestyle.
Evaluate the cortisol level, perform any relevant diagnostic test on a periodic basis to make sure that the disease is not progressive, and cortisol level is return to normal.
Lifestyle Modifications: Include a balanced diet and exercise. Get proper sleep for good health. Stress reduction techniques like mediation. Yoga, mindfulness may help o control the stress levels.
Psychological Support: Psychological support and care may be helpful to manage the diseases like chronic stress or depression.
Endocrinology, Metabolism
Healthy Lifestyle Changes: Include a healthy lifestyle like a balanced diet and regular exercise. Weight management is important.
Medication Review: Review the medications which is taken by patients like corticosteroids can cause symptoms of PCS. Adjust or change these medications.
Psychological Support: Give psychological support and counseling if depression, stress, or anxiety are contributing factors. Cognitive behavioral therapy will also help.
Monitor Health: DO regular check-ups and monitor the symptoms are necessary. This can help to track the progress of disease and if the treatment is effective or not.
Avoidance of Alcohol and Other Triggers: Treat alcohol abuse disease or other substances for proper treatment.
Educational Support: Educate people about the condition and how to manage it.
Collaboration with Healthcare Professionals: Collaborate with medical professionals like psychologists, nutritionists, and endocrinologists to develop treatment plans.
Endocrinology, Reproductive/Infertility
Selective Serotonin Reuptake Inhibitors (SSRIs):
Sertraline and fluoxetine: It is used to treat anxiety and depression. It is linked with PCS. These medications help to reduce the symptoms of depression and stress related activation of HPA axis.
Endocrinology, Reproductive/Infertility
Diagnosis and Identification of Underlying Cause: This includes a medical history, physical examination, and different tests like urinary free cortisol, low dose dexamethasone suppression test, late night salivary cortisol.
Identification and Treatment of Underlying Conditions: PCS may be caused by different diseases like depression, obesity, alcoholism, PCOS. Manage these disease include multidisciplinary approaches with psychiatry, endocrinology, gynecologist. Treatment may need medications, lifestyle medications or therapy.
Medication Adjustment or Withdrawal: Medications like corticosteroids are known to mimic PCS. Continuously manage the medications on regular basis to avoid adverse effects.
Monitoring and Follow-up: Take follow up tests to monitor the cortisol level and check the symptoms as recommended by healthcare providers.
Long-Term Management: Continue monitor and manage the underlying conditions is necessary to control the disease for long term.
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