Cushing syndrome due to excessive use of corticosteroids
DOI:
https://doi.org/10.35319/conr.20213133Keywords:
Hypercortisolism, glucocorticoids, syndrome, obesity, cortisolAbstract
Cushing syndrome (CS) is a state of hypercortisolism that results from chronic exposure to elevated serum levels of exogenous glucocorticoids due to iatrogenic causes when glucocorticoids are used as endogenous and prolonged anti-inflammatory therapy for a neoplasm that secretes adrenocorticotropin hormone (ACTH) or an autonomous secretion of cortisol from a benign or malignant adrenal neoplasm. The clinical manifestations are variable and differ in severity depending on the degree and duration of hypercortisolism. Central obesity is the most common manifestation and is often the initial sign. In addition, it is common to find full moon fascies, accumulation of fat in the cervicodorsal and supraclavicular region, purple striae, thinning of the skin, weakness in the proximal muscles, fatigue, arterial hypertension, acne, hirsutism, glucose intolerance, muscle atrophy, ecchymosis, osteoporosis and even neuropsychological disorders such as depression, irritability and cognitive dysfunction. A detailed medical history is recommended to establish whether there is a history of high-dose glucocorticoid use as a cause of exogenous CS. The clinical practice guidelines of the Endocrine Society recommend the measurement of screening tests to demonstrate the presence of hypercortisolism and the mismatch in the physiological feedback of the hypothalamic-pituitary-adrenal axis, such as the determination of nocturnal salivary cortisol levels, free cortisol 24 h urine and serum cortisol after dexamethasone suppression test.
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