PCOS versus Cushing's syndrome

Dear Ask The Doctor: I was diagnosed with, PCOS before I was even a teen at around age 10-12 (I started menstruating at 10), But I have the buffalo hump & apple shape of someone with cushing's syndrome, I am fat 260lbs. but nearly all my mass is on my upper back & neck & around my middle. I also have hirsutism & a very pronounced eyebrow bone & chubby cheaks, I have always had anxiety problems & suffer from weakness, headaches, & a "need" for foods high in carbs. So I'm thinking maybe I don't have PCOS? Could it be cushing's? The only thing that makes me have doubts about cushing's is I have had a number of both MRI's & CT scans in the last 2 years due to ahead injury that caused seizures & isn't cushing's normally due to a tumor on your pituitary, So wouldn't the head scans have picked that up? I'm so lost & sick of being sick & do not trust Drs. anymore.

Dear Jessica: The possible presence of Cushing's syndrome is suggested by certain symptoms and signs. Many of these are nonspecific (eg, obesity, high blood pressure, menstrual irregularity, and glucose intolerance). The diagnosis of Cushing’s syndrome is based on the laboratory finding of high cortisol levels. High blood cortisol levels can occur in several disorders other than Cushing's syndrome, including polycystic ovary syndrome. Therefore this explains why there may be an overlap in symptoms between Cushing’s and PCOS. PCOS is diagnosed by defined criteria including high androgen (sex hormone) levels in the blood, and physical signs of this including (acne, hirsutism etc.); the presence of polycystic ovaries on ultrasound scan; and menstrual irregularities. I think it is unlikely that you have been misdiagnosed, however I would advise discussing your concerns with your family doctor or OBGYN for reassurance.