Exogenous Cushing’s Syndrome with Subsequent Secondary Adrenal Insufficiency in Patients with Long Term Steroid Usage

Abstract

Exogenous Cushing’s syndrome is a collection of symptoms and clinical signs due to elevated levelsof glucocorticoids (cortisol) in the blood because of prolonged consumption of glucocorticoid drugs.Glucocorticoids were introduced in the 1950s and have been used for anti-inflammatory treatment. Withdrawalof glucocorticoids can lead to complications of secondary adrenal insufficiency caused by suppression ofthe Hypothalamic-Pituitary-Adrenal (HPA) axis. Male, 28 years old, with weakness in both hands and feetthroughout 3 days before admission to hospital. Other complaints include nausea (+), vomiting (+), diarrhea(-). He had been taking dexamethasone daily in the past 3 years until one month ago when he suddenlystopped. Physical examination revealed moon facies (+), striae (+) in the abdomen, and motor strength of 2in all four extremities. Laboratory: K 2.0 mmol/L, Mg 0.8 mg/dL, GDA 64 mg/dL, Total cholesterol 240 mg/dL, cortisol 18.67 ng/mL, ACTH 2.1 pg/mL. The patient was diagnosed with exogenous Cushing’s syndromebased on a history of long-term use of dexamethasone. Physical examination revealed moon face, buffalohump, purplish striae, and hypertension. The patient stopped dexamethasone consumption suddenly and isconsequently experiencing secondary adrenal insufficiency at the present time. As evidenced by laboratoryvalues, there was a decrease in serum cortisol (18.67 ng/mL), as well as a decrease in serum ACTH (2.1 pg/mL). Based on the history of dexamethasone use, physical examination, and laboratory results, this patienthad exogenous Cushing’s syndrome. Sudden discontinuation of dexamethasone results in withdrawalsymptoms in the form of secondary adrenal insufficiency as indicated by low cortisol and ACTH values.