Induction of Prolonged Cushing’s Syndrome Due to Prolonged Therapeutic Use of Corticosteroids

Abstract

Background: The long-term ingestion of external corticosteroids can lead to iatrogenic Cushing’s syndrome and are known to be adverse drug reactions that are prevented. There are many nonspecific symptoms associated with iatrogenic Cushing’s syndrome that often mimic other dermatologic or systemic conditions and may therefore go undetected. If there has been long-term use of an external corticosteroid, there are also considerations if the external corticosteroid is withdrawn suddenly. It can lead to a delayed crisis. Case Report: 53-year-old hypertensive female patient presented with skin thickening and hyperpigmentation over the abdomen and the lower extremities; generalized pruritus; exertional dyspnea; weakness; recent history of a chest pain; and fall. The patient reported medical history of taking chronic non-steroidal anti-inflammatory medication and external corticosteroids for joint pain. Clinical examination showed pallor, mild pedal edema, hypertension, skin atrophy, and scaliness. When laboratory tests were performed, low serum cortisol levels, concentric left ventricular hypertrophy with diastolic dysfunction Grade I, mild anemia, thrombocytopenia, hyperbilirubinemia, and mild renal impairment were obtained. Treatment/ Results: The patient was treated with antihypertensives, supportive care, gradual tapering of steroids and dermatology consult. Conclusion: This case demonstrates that there is chronic adrenal suppression from due to long-term exposure of corticosteroids. Low cortisol level confirms the diagnosis of Cushing’s syndrome due to exogenous steroid use as compared to endogenous causes. In the evaluation of abnormal skin or systemic changes, always ask the patient about use of corticosteroids; it is important to taper corticosteroids appropriately so sudden withdrawal does not result in a crisis