Epilepsy can induce hypercortisolism secondary to altered temporolimbic modulation of the hypothalamopituitary secretion of ACTH.1 2 Hypercortisolism can produce a reversible myopathy. Epilepsy, however, has not been recognised to cause a symptomatic Cushing’s syndrome. The development of proximal myopathy as part of an epilepsy based Cushing’s syndrome, in particular, has not been reported. We report on three such patients as well as their successful treatment with normalisation of serum cortisol using ketoconazole.3

Three women (table) with epilepsy who complained of easy fatiguability, had mild to moderate weakness of trunk, neck, and upper and lower limb girdle muscles. All had irregular menses and hirsutism. They had increased serum ACTH concentrations and serum and 24 hour urinary cortisol concentrations. Weakness was persistent in two and intermittent, correlating exclusively with periods of seizure exacerbation and raised cortisol …