Iatrogenic cushing syndrome

Background: Iatrogenic Cushing's syndrome is a disorder caused by overuse of steroid medications in supra physiological doses for a long period. Case Report: A 6-month old female child was seen in the pediatric clinic for full faces, hypertrichosis, and overweight following 2 months use of topical Dermovate. Repeated levels of cortisol done at 8 a.m. were persistently low; measuring 40 n mol/L normal (150-630). That's fail to rise with short ACTH stimulation test. Conclusion: Medical education programs which highlight the serious effects of steroid misuse with increase awareness among public and physicians should be undertaken. Stringent laws for restricting the over counter dispensing of harmful drugs by untrained persons should be established.

The Journal of clinical endocrinology and metabolism, 2017

Patients with 21-hydroxylase deficiency congenital adrenal hyperplasia (CAH) require lifelong treatment with glucocorticoids. In growing children the drug of choice is hydrocortisone. Commercially available hydrocortisone tablets do not conform to very low doses prescribed to infants and toddlers, and compounded hydrocortisone is often dispensed to meet therapeutic needs. However, safety, efficacy and uniformity of compounded products are not tested. We report a case of Cushing syndrome in a child with CAH who was inadvertently receiving excessive hydrocortisone in compounded form. A 20 month old girl with congenital adrenal hyperplasia developed growth deceleration, excessive weight for length, irritability, increased facial fat, plethora and excess body hair, while receiving hydrocortisone from a local compounding pharmacy. The signs and symptoms persisted despite decreasing hydrocortisone dose. Iatrogenic Cushing syndrome was suspected. The prescribed hydrocortisone capsules were...

Pan African Medical Journal, 2014

Cushing syndrome is a hormonal disorder caused by prolonged exposure of body tissue to cortisol. We report two cases of iatrogenic Cushing's syndrome in two Nigerian children following intranasal administration of aristobed-N (Betamethasone+Neomycin) given at a private hospital where the children presented with feature of adenoidal hypertrophy. Two months into treatment children were noticed to have developed clinical and laboratory features of iatrogenic Cushing's syndrome with critical adrenal suppression. Serum cortisol (at presentation): 1 st patient: 12nmol/L (reference range 240-618), 2 nd Patient: 1.69nmol/L. Serum cortisol (3 months after weaning off steroid): 343.27 nmol/L (within normal range for the first patient; second patient newly presented and has just begun steroid weaning off process. The serum cortisol level one month into weaninig off process was 128 nmol/L). Unsupervised topical steroid administration in children can cause adrenal suppression with clinical features of Cushing's syndrome.

Clinics in Perinatology, 2018

Neonatal Cushing syndrome (CS) is most commonly caused by exogenous administration of glucocorticoids and rarely by endogenous hypercortisolemia. CS due to adrenal lesions is the most common cause of endogenous CS in neonates and infants, and adrenocortical tumors (ACTs) represent the majority of cases. Many of the ACTs develop in the context of a TP53 gene mutation, which causes Li-Fraumeni syndrome. More rarely neonatal CS presents as part of other syndromes such as McCune-Albright syndrome (MAS) or Beckwith-Wiedemann syndrome (BWS). The management of the patients usually includes resection of the primary tumor with or without additional medical treatment, but manifestations may persist after resolution of hypercortisolemia.

Case Reports in Endocrinology

Cushing syndrome is a state of hypercortisolism from exogenous or endogenous exposure to glucocorticoids resulting in various clinical manifestations. In this case report, we present a case of a 15-month-old child who presented with cushingoid facies due to over-the-counter misuse of a very potent topical steroid (clobetasol 0.05%) for suspected scabies. Laboratory measurement of urinary free cortisol level was low, and 8 : 00 am basal cortisol level was measured, which was decreased, which confirmed the diagnosis of Cushing syndrome due to exogenous source. Over-the-counter topical steroids should not be used, and one should always consult a registered medical practitioner before using such products. Physicians when prescribing topical steroids should warn patients about the potential side effects of prolonged use of topical steroids.

Journal of Diabetes and Endocrinology Association of Nepal, 2023

Cushing syndrome (CS) is an endocrinological disorder characterized by increased blood cortisol level. It is either due to an excessive endogenous release of steroids (e.g., pituitary adenoma or adrenal hyperplasia) or exogenous administration of steroids. Iatrogenic cushing syndrome is the most common form of cushing syndrome. The vast majority of cases are due to oral or parenteral steroid preparations, which are commonly prescribed for pulmonary, renal, hematological or autoimmune diseases. Prolonged use of topical corticosteroids, particularly in children, may cause Cushing syndrome and suppression of the hypothalamo-pituitory-adrenal (HPA) axis, which is less common than that of oral or parenteral route. Iatrogenic CS due to the overuse of topical corticosteroids is rarely reported. There are only few cases that reported young children having cushing syndrome secondary to misuse of topical corticosteroids.

Endocrinology and Metabolism Clinics of North America, 2012

Corticotropin (ACTH)-releasing hormone (CRH) is synthesized in the hypothalamus and carried to the anterior pituitary in the portal system. CRH stimulates ACTH release from the anterior pituitary, which in turn stimulates the adrenal cortex to secrete cortisol (hypothalamic-pituitaryadrenal or HPA axis). 1-4 Cortisol inhibits the synthesis and secretion of both CRH and ACTH in a negative feedback regulation system. In Cushing syndrome, the HPA axis has lost its ability for self-regulation, due to excessive secretion of either ACTH or cortisol and the loss of the negative feedback function. Diagnostic tests, on the other hand, take advantage of the tight regulation of the HPA axis in the normal state and its disturbance in Cushing syndrome to guide therapy toward the primary cause of this disorder.

Clinical Endocrinology, 2003

2024

In recent years, the interest on life and work of the Jewish writer, philosopher, mystic and politician Shmuel Hugo Bergmann (1883–1975) has perceptibly increased. Well-known as a protagonist of the famous "Prague Circle", Bergmann headed for Palestine in 1920, became the driving force for building the Jewish National Library in Jerusalem and finally advanced as first Rector of the Hebrew University. All his life, close ties to the Czech Republic remained. In the State of Israel, Bergmann became a leading philosopher and highly admired cultural figure. He himself showed great interest in world religions, mysticism, and Western esotericism. Bergmann also emerged as an important point of reference for left-wing Israeli discourse. Up from the late 1920ies has was one of the protagonists of the “Brit Shalom”, an initiative which called for an advocated peaceful coexistence of Jews and Arabs and a bi-national State in Israel/Palestine. In this volume, distinguished historians, scholars of religion, and cultural scientists conflate a fascinating life story of a man who always worked on social and educational improvements and searched for fairness and deeper truths in a world full of conflict and antagonisms.