Cushing syndrome - exogenous
Exogenous Cushing syndrome is a form of Cushing syndrome
that occurs in people taking glucocorticoid (also called corticosteroid) hormones, such as prednisone.
Cushing syndrome - corticosteroid induced; Corticosteroid-induced Cushing syndrome; Iatrogenic Cushing syndrome; Exogenous Cushing syndrome
Causes, incidence, and risk factors
Exogenous means caused by something outside the body. Exogenous Cushing syndrome occurs when a person takes human-made (synthetic) glucocorticoids, such as prednisone or dexamethasone, for treatment purposes (for example, to treat asthma).
In Cushing syndrome, the adrenal glands
produce too much of certain hormones, such as cortisol.
For other causes and more information about Cushing syndrome, see:
Symptoms usually include:
- Upper body obesity (above the waist) and thin arms and legs
- Round, red, full face (moon face
- Slow growth rate in children
Skin changes that are often seen:
or skin infections
- Purple marks (1/2 inch or more wide), called striae, on the skin of the abdomen, thighs, and breasts
- Thin skin with easy bruising
Muscle and bone changes include:
- Backache, which occurs with routine activities
- Bone pain or tenderness
- Collection of fat between the shoulders (buffalo hump
- Thinning of the bones, which leads to rib and spine fractures
- Weak muscles
Women often have:
- Excess hair growth on the face, neck, chest, abdomen, and thighs
- Menstrual cycle that becomes irregular or stops
Men may have:
Other symptoms that may occur include:
- Mental changes
, such as depression, anxiety, or changes in behavior
- Increased thirst and urination
Signs and tests
In people who use cortisone, prednisone, or other corticosteroids, the following test results may suggest exogenous Cushing syndrome:
- Low ACTH
- Low cortisol level
- No response to a cosyntropin stimulation test
- Higher than normal fasting glucose
- Low blood potassium
- Low bone density, as measured by dual x-ray absorptiometry (DEXA)
- High cholesterol, particularly high triglycerides and low high-density lipoprotein (HDL)
A method called high performance liquid chromatography (HPLC) can show high levels of the suspected medication in the urine.
The suggested treatment is to slowly decrease and eventually stop taking any corticosteroids. Do not stop taking any medicine without first talking to your health care provider.
If you cannot stop taking the medication because of disease (for example, if you need steroids to treat severe asthma), make every effort to reduce the possibility of developing complications.
Slowly tapering off the drug that is causing the condition can help reverse the effects of adrenal gland shrinkage (atrophy), although this may take as long as a year. During this time, you may need to restart or increase the dosage of your steroids in times of stress or illness.
Damage to the eyes, kidneys, and nerves due to untreated high blood sugar
Increased risk of heart attack from untreated diabetes and high cholesterol
These complications can generally be prevented with proper treatment.
Calling your health care provider
Call for an appointment with your health care provider if you are taking a corticosteroid drug and you develop symptoms of Cushing syndrome.
Awareness of the signs and symptoms of Cushing syndrome may make early treatment possible for patients who take corticosteroids. If you use inhaled steroids, you can decrease your exposure to the steroids by using a “spacer,” and by rinsing your mouth after breathing in the steroids.
Stewart PM, Krone NP. The adrenal cortex. In: Kronenberg H, Melmed S, Polonsky K, Larsen PR, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 15.
Nancy J. Rennert, MD, Chief of Endocrinology & Diabetes, Norwalk Hospital, Associate Clinical Professor of Medicine, Yale University School of Medicine, New Haven, CT. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.