Does critical illness cause reversible Cushing’s like syndrome? A case study of two case reports and review of the literature

An activation of the hypothalamic-pituitary-adrenal axis (HPA) and elevated cortisol levels are common during critical illness. Clinically evident Cushing’s syndrome, triggered by life threatening illness, has not been previously reported. We describe two patients with adrenocorticotropic hormone (ACTH)-dependent Cushing’s syndrome, which developed during the life threatening illness and later spontaneously remitted. The impact of the acute and prolonged phase of critical-illness on the function of HPA axis with its complex neuroimmunoendocrine dynamics has been reviewed.   Key words: Adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome, hypothalamic-pituitary-adrenal axis, critical illness.