Cushing Syndrome Due to Surreptitious Glucocorticoid Administration
Abstract
We report a case of subtle Cushing syndrome in a Pakistani man who self-treated his asthma with a potent long-acting oral glucocorticoid (betamethasone disodium phosphate [Bentelan]) for more than 30 years. He presented with cushingoid features, insulin resistance, and refractory hypertension. Laboratory evaluation revealed undetectable cortisol levels and suppression of the hypothalamic-pituitary-adrenal axis. The patient obtained the drug from his country of origin, with no understanding of the potential adverse effects imposed by long-term use of steroids. He is now being slowly weaned off the drug. The apparent widespread availability, access, and abuse of such potent steroids are a cause of concern in developing countries. We suggest that physicians in the United States be aware of the potential abuse of such potent drugs in all populations, including immigrants.
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Glucocorticoids in excess induce insulin resistance.
“Glucocorticoids in excess induce insulin resistance.”
Cites
Natural History of Pituitary-Adrenal Recovery Following Long-Term Suppression with Corticosteroids1
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Diseases of the adrenal cortex
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Ruzzin, J., Wagman, A. S., & Jensen, J. (2005) · Diabetologia · doi:10.1007/s00125-005-1886-0 · Cited by 243 · see citing works
- Authors
- Quddusi, S., Browne, P., Toivola, B., & Hirsch, I. B.
- Affiliations
- University of Washington (US)
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 1998-02-09
- Volume
- 158
- Issue
- 3
- Pages
- 294
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2018928170
- Cited by
- 44
- References
- 8
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 3 · 2022: 1 · 2020: 1 · 2017: 1 · 2015: 3 · 2012: 2
- FWCI
- 1.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
- Keywords
- Cushing's syndrome, self-medication, asthma, insulin resistance, resistant hypertension, hypothalamic-pituitary-adrenal axis suppression, corticosteroid withdrawal, immigrants
- MeSH terms
- Asthma, Betamethasone, Cushing Syndrome, Humans, Male, Middle Aged, Self Medication
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