Diagnosis And Treatment Of Iatrogenic Cushing’s Syndrome Caused By Dexamethasone

Objective: To study the pathogenesis, diagnosis, treatment and prevention of iatrogenic Cushing syndrome caused by dexamethasone.Methods: Twenty subjects from Zhongshan Hospital Xiamen University were enrolled from January 2003 to January 2015. All the patients with iatrogenic Cushing syndrome had been treated with high-dose dexamethasone for a long time because of different causes(such as gout, asthma, rheumatism, rheumatoid arthritis, lumbar tuberculosis). Twenty cases were advised to stop the dexamethasone, replaced with prednisone or hydrocortisone, and treated with concomitant adrenal insufficiency or adrenal crisis. The doses of prednisone or hydrocortisone gradually reduced, and some patients stopped the corticosteroid completely. We compared with the clinical manifestations before and after treatment, including truncal obesity, moon face, violaceous striaes, adema, and metabolic indicators before and after treatment, including serum potassium, fasting glucose, total cholesterol(TC), triglyceride(TG), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C) levels, and hormone levels, including serum cortisol(8:00am, 4:00pm, 12:00pm) and adrenocorticotropic hormone(ACTH 8:00am, 4:00pm, 12:00pm).Results: ①Truncal obesity, moon face, violaceous striaes, adema were alleviated after therapy compared with pretreatment(P<0.01 respectively). ②The levels of fasting glucose, TC, TG, LDL-C decreased(P<0.05~0.01, respectively) and serum potassium, HDL-C increased after therapy compared with pretreatment(P<0.01,respectively). ③After treatment, the levels of serum cortisol and ACTH increased(P<0.05~0.01, respectively), also the circadian rhythm of cortisol and ACTH recovered to normal.Conclusions: Long-term administration of dexamethasone can induce iatrogenic Cushing syndrome. It is of great importance for the clinicians, especially clinicians from basic hospital to prescribe the glucocorticoid correctly and reduce the side effects.