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Iatrogenic Cushing Syndrome

Updated : April 17, 2024





Background

Iatrogenic Cushing Syndrome is causes due to prolonged administration or overdose of glucocorticoid drug. It is a condition which develops because of medical interventions. 

Glucocorticoids are widely suggested by physicians to treat various inflammatory and autoimmune conditions. This suppress the immune system in cases of organ transplantation. 

This syndrome arises due to an excess level of cortisol. It is a steroid hormone which is derived from the adrenal glands. 

Epidemiology

The Prevalence is depending on population, duration, and dose of glucocorticoid therapy. 

The high risk for patients is noticed with certain medical conditions due to prolonged use. For Short-term use the low-dose therapy is less likely to develop the syndrome. 

The high-level dose of glucocorticoids and extended durations of treatment develops the risk of syndrome.  

 

Anatomy

Pathophysiology

Prednisone and dexamethasone bind to glucocorticoid receptors in cells. 

Glucocorticoids initiate cellular responses then modulate into gene expression. 

Exogenous glucocorticoids gives negative feedback on HPA axis, so they reduces CHR and ATH release. 

 

Etiology

The risk of developing Iatrogenic Cushing Syndrome is often dose dependent.  

It is prescribed by physicians in conditions like autoimmune diseases, inflammatory disorders, asthma, and organ transplantation. 

 

Genetics

Prognostic Factors

An early identification and timely intervention treatment can help to improve prognosis. 

The symptoms reversible upon discontinuation and tapering of glucocorticoid therapy. 

The reversibility based on duration of exposure and susceptibility of individual. 

Clinical History

Clinical History: 

In children and adolescents if physician suggested glucocorticoids drugs, then it can lead to syndrome. 

Pediatric patients are more vulnerable to glucocorticoid therapy effects. 

Physical Examination

Cardiovascular Examination 

Musculoskeletal Examination 

Joint Examination 

Neurological and Psychological Assessment 

Age group

Associated comorbidity

Prolonged exposure to high levels of glucocorticoids can lead to decreased bone mineral density and an increased risk of osteoporosis. Iatrogenic Cushing Syndrome is associated with an increased risk of cardiovascular complications, including hypertension, atherosclerosis, and an elevated risk of cardiovascular events such as heart attacks and strokes. 

Glucocorticoids can induce metabolic changes, including insulin resistance, impaired glucose tolerance, and an increased risk of developing diabetes mellitus. One of the characteristic features of Cushing Syndrome is central obesity, with an accumulation of fat around the abdomen and face.

This can contribute to weight gain and an increased risk of metabolic syndrome. Glucocorticoids can lead to muscle wasting and weakness, which may contribute to decreased physical function and exercise intolerance. 

Associated activity

Acuity of presentation

In many cases symptoms occurs gradual development over time with prolonged glucocorticoid use. 

Initial body composition shows changes like weight gain and fat redistribution. 

The systemic effects of glucocorticoids shows endocrine disturbances and menstrual irregularities. 

 

Differential Diagnoses

Primary Adrenal Disease:  

Exogenous Glucocorticoid Use  

Pseudo-Cushing Syndrome 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

Adrenal function monitoring importance is essential during and after tapering process. 

Psychological support is beneficial for mood changes or emotional distress. 

Patients should follow a healthy diet and lifestyle can shows metabolic consequences of glucocorticoid therapy. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Use of non-pharmacological approach for Iatrogenic Cushing Syndrome

A balanced and nutritious diet should be taken to support overall health.  

Consume a variety of fruits, vegetables, whole grains, and lean proteins. 

Do regular physical activity and exercise which can contribute to weight management and muscle strength. 

Follow regular sleep patterns to support well-being. 

Role of supplements for bone health

To give support and strength to bone health patient should take supplements like calcium and vitamin D. 

Role of glucocorticoid therapy

Hydrocortisone is a synthetic form of cortisol. It is used in the management of Iatrogenic Cushing Syndrome. 

Use of Intervention with a procedure in treating Iatrogenic Cushing Syndrome

The size and appearance of the adrenal glands is examined in the imaging studies. 

DXA scans are used to determine bone mineral density. It helps in evaluation of glucocorticoid therapy on bone health and the risk of osteoporosis. 

Use of phases in managing Iatrogenic Cushing Syndrome

The diagnosis phase involves the initial identification of the signs and symptoms of Cushing Syndrome. This includes central obesity, moon face, muscle weakness, and psychological changes. 

On regular basis monitor adrenal function during the tapering process to assess recovery. 

Schedule regular follow-up to monitor the patient’s progress.  

Medication

Media Gallary

Iatrogenic Cushing Syndrome

Updated : April 17, 2024




Iatrogenic Cushing Syndrome is causes due to prolonged administration or overdose of glucocorticoid drug. It is a condition which develops because of medical interventions. 

Glucocorticoids are widely suggested by physicians to treat various inflammatory and autoimmune conditions. This suppress the immune system in cases of organ transplantation. 

This syndrome arises due to an excess level of cortisol. It is a steroid hormone which is derived from the adrenal glands. 

The Prevalence is depending on population, duration, and dose of glucocorticoid therapy. 

The high risk for patients is noticed with certain medical conditions due to prolonged use. For Short-term use the low-dose therapy is less likely to develop the syndrome. 

The high-level dose of glucocorticoids and extended durations of treatment develops the risk of syndrome.  

 

Prednisone and dexamethasone bind to glucocorticoid receptors in cells. 

Glucocorticoids initiate cellular responses then modulate into gene expression. 

Exogenous glucocorticoids gives negative feedback on HPA axis, so they reduces CHR and ATH release. 

 

The risk of developing Iatrogenic Cushing Syndrome is often dose dependent.  

It is prescribed by physicians in conditions like autoimmune diseases, inflammatory disorders, asthma, and organ transplantation. 

 

An early identification and timely intervention treatment can help to improve prognosis. 

The symptoms reversible upon discontinuation and tapering of glucocorticoid therapy. 

The reversibility based on duration of exposure and susceptibility of individual. 

Clinical History: 

In children and adolescents if physician suggested glucocorticoids drugs, then it can lead to syndrome. 

Pediatric patients are more vulnerable to glucocorticoid therapy effects. 

Cardiovascular Examination 

Musculoskeletal Examination 

Joint Examination 

Neurological and Psychological Assessment 

Prolonged exposure to high levels of glucocorticoids can lead to decreased bone mineral density and an increased risk of osteoporosis. Iatrogenic Cushing Syndrome is associated with an increased risk of cardiovascular complications, including hypertension, atherosclerosis, and an elevated risk of cardiovascular events such as heart attacks and strokes. 

Glucocorticoids can induce metabolic changes, including insulin resistance, impaired glucose tolerance, and an increased risk of developing diabetes mellitus. One of the characteristic features of Cushing Syndrome is central obesity, with an accumulation of fat around the abdomen and face.

This can contribute to weight gain and an increased risk of metabolic syndrome. Glucocorticoids can lead to muscle wasting and weakness, which may contribute to decreased physical function and exercise intolerance. 

In many cases symptoms occurs gradual development over time with prolonged glucocorticoid use. 

Initial body composition shows changes like weight gain and fat redistribution. 

The systemic effects of glucocorticoids shows endocrine disturbances and menstrual irregularities. 

 

Primary Adrenal Disease:  

Exogenous Glucocorticoid Use  

Pseudo-Cushing Syndrome 

Adrenal function monitoring importance is essential during and after tapering process. 

Psychological support is beneficial for mood changes or emotional distress. 

Patients should follow a healthy diet and lifestyle can shows metabolic consequences of glucocorticoid therapy. 

A balanced and nutritious diet should be taken to support overall health.  

Consume a variety of fruits, vegetables, whole grains, and lean proteins. 

Do regular physical activity and exercise which can contribute to weight management and muscle strength. 

Follow regular sleep patterns to support well-being. 

To give support and strength to bone health patient should take supplements like calcium and vitamin D. 

Hydrocortisone is a synthetic form of cortisol. It is used in the management of Iatrogenic Cushing Syndrome. 

The size and appearance of the adrenal glands is examined in the imaging studies. 

DXA scans are used to determine bone mineral density. It helps in evaluation of glucocorticoid therapy on bone health and the risk of osteoporosis. 

The diagnosis phase involves the initial identification of the signs and symptoms of Cushing Syndrome. This includes central obesity, moon face, muscle weakness, and psychological changes. 

On regular basis monitor adrenal function during the tapering process to assess recovery. 

Schedule regular follow-up to monitor the patient’s progress.