ACTH is usually less than 10 pg/mL in primary adrenal disorders but is also suppressed by exogenous steroids, whether they are prescribed intentionally (iatrogenic Cushing's syndrome) or taken factitiously.

Iatrogenic Cushing's syndrome, induced by the administration of glucocorticoids or other steroids such as megestrol that bind to the glucocorticoid receptor, is indistinguishable by physical findings from endogenous adrenocortical hyperfunction. The distinction can be made, however, by measuring blood or urine cortisol levels in a basal state; in the iatrogenic syndrome these levels are low secondary to suppression of the pituitary-adrenal axis.

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