Abstract

EXOGENOUS CUSHING SYNDROME SECONDARY TO CORTICOSTEROID THERAPY: A CASE REPORT WITH METABOLIC AND CLINICAL IMPLICATIONS

G. A. Mary Lydia*, G. Akshita, P. Sarmas Vali, Dr. Syed Mohammed Hussaini

Abstract

Introduction: Cushing syndrome is an endocrine disorder caused by prolonged excess cortisol, most commonly due to extended use of exogenous glucocorticoids. Chronic steroid exposure suppresses the hypothalamic–pituitary–adrenal axis, resulting in decreased endogenous cortisol production and adrenal atrophy. Patients typically present with central obesity, facial rounding, thin skin, violaceous striae, proximal muscle weakness, hypertension, and diabetes. Early diagnosis through clinical assessment and biochemical evaluation is crucial for appropriate management. Case Presentation: A 68-year-old female presented with altered sensorium, high-grade fever, and vomiting for three days. On examination, she had mild tachycardia. Laboratory investigations revealed leukocytosis, hyperglycemia, dyslipidemia, hyponatremia, and abnormal serum cortisol levels. She was treated with intravenous antibiotics, corticosteroids, insulin, antihypertensives, and supportive care. Upon stabilization, she was discharged on oral hydrocortisone, antidiabetic therapy, and other supportive medications. Case discussion: This case highlights exogenous Cushing syndrome as a preventable complication of prolonged glucocorticoid therapy. The patient’s metabolic abnormalities and altered cortisol levels suggested steroid-induced suppression of the hypothalamic–pituitary–adrenal axis. As recommended by the Endocrine Society guidelines, a detailed medication history is central to diagnosis. Management included gradual hydrocortisone tapering and correction of metabolic disturbances. Conclusion: Exogenous Cushing syndrome remains a common yet preventable cause of hypercortisolism. Rational steroid prescribing, careful monitoring, and gradual tapering are essential to prevent adrenal insufficiency and systemic complications, particularly in elderly patients.

Keywords: Adrenal suppression, Corticosteroids, Hypothalamic–pituitary–adrenal axis suppression, Iatrogenic Cushing syndrome, Steroid-induced metabolic complications.