scholarly journals Iatrogenic Cushing’s syndrome and Secondary Adrenal Insufficiency in an HIV Patientreceiving Fluticasone and Ritonavir

2014 ◽  
Author(s):  
Vlasved, Imro ◽  
O. van Aken, Maarten
Keyword(s):  
Adrenal Insufficiency ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Secondary Adrenal Insufficiency ◽  
Iatrogenic Cushing’S Syndrome

scholarly journals Too little or too much corticosteroid? Coexisting adrenal insufficiency and Cushing's syndrome from chronic, intermittent use of intranasal betamethasone

2013 ◽  
Vol 2013 ◽  
Author(s):  
Adrienne Dow ◽  
Run Yu ◽  
John Carmichael
Keyword(s):  
Adrenal Insufficiency ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
High Dose ◽  
List Type ◽  
Secondary Adrenal Insufficiency ◽  
Severe Fatigue ◽  
Learning Points ◽  
Endocrinology Clinic ◽  
Iatrogenic Cushing’S Syndrome

Summary To report the puzzling, rare occurrence of coexisting adrenal insufficiency and Cushing's syndrome from chronic, intermittent use of intranasal betamethasone spray. A 62-year-old male was referred to our endocrinology clinic for management of adrenal insufficiency. This previously healthy individual began to experience chronic sinus symptoms in 2007, was treated with multiple ensuing sinus surgeries, and received oral glucocorticoid for 6 months. In the following 5 years, he suffered severe fatigue and was diagnosed with secondary adrenal insufficiency. He could not be weaned from corticosteroid and developed clear cushingoid features. In our clinic, careful inquiry on medications revealed chronic, intermittent use of high-dose intranasal betamethasone since 2008, which was not apparent to his other treating physicians. His cushingoid features significantly improved after holding intranasal betamethasone. Learning points Chronic, intermittent intranasal betamethasone can cause secondary adrenal insufficiency and iatrogenic Cushing's syndrome when used in excess. Topical corticosteroid use should be considered in the differential diagnosis of adrenal insufficiency or Cushing's syndrome.

scholarly journals Iatrogenic Cushing’s Syndrome with Subsequent Adrenal Insufficiency in a Patient with Psoriasis Vulgaris Using Topical Steroids

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Suzan Demir Pektas ◽  
Gursoy Dogan ◽  
Nese Cinar
Keyword(s):  
Adrenal Insufficiency ◽  
Cushing’S Syndrome ◽  
Psoriasis Vulgaris ◽  
Topical Steroid ◽  
Cushing's Syndrome ◽  
Chronic Inflammatory Disease ◽  
High Dose ◽  
Topical Steroids ◽  
First Choice ◽  
Iatrogenic Cushing’S Syndrome

Iatrogenic Cushing’s syndrome (ICS) is usually related to prolonged and/or high-dose oral or parenteral steroid use. Psoriasis vulgaris (PV) is chronic inflammatory disease and characterized by periods of attack and remission. Topical steroid (TS) is the first choice of treatment for localized and mild PV. The development of systemic side effects of the steroids is usually not observed after TS application. But the risk of developing ICS still exists. In the literature, there are a few adult cases who developed ICS and subsequent adrenal insufficiency associated with TS. In this article, a male patient with PV developing ICS and secondary adrenal insufficiency after treatment of TS for 12 years is presented.

scholarly journals Thrombospondin-1 is a glucocorticoid responsive protein in humans

2016 ◽  
Vol 174 (2) ◽  
pp. 193-201 ◽  
Author(s):  
Johanna L Barclay ◽  
Carolyn J Petersons ◽  
Sahar Keshvari ◽  
Jane Sorbello ◽  
Brenda L Mangelsdorf ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Adrenal Insufficiency ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Matricellular Protein ◽  
Mrna Levels ◽  
Secondary Adrenal Insufficiency ◽  
Interventional Study ◽  
Peripheral Blood Mononuclear ◽  
Thrombospondin 1

ObjectiveThrombospondin-1 (TSP1) is a matricellular protein whose gene expression has previously been shown to increase acutely after exposure to dexamethasone in vitro. The aim of this study was to determine if TSP1 is altered by acute and chronic states of glucocorticoid excess in human subjects.Design and methodsThree studies have been undertaken to assess the difference or change in TSP1 in response to altered glucocorticoid activity: i) an acute interventional study assessed the effects of a single 4 mg dose of dexamethasone in 20 healthy volunteers; ii) a cross-sectional study compared plasma TSP1 in 20 healthy volunteers and eight patients with Cushing's syndrome; iii) an interventional study assessed the effect on plasma TSP1 of an increase in hydrocortisone dose from ≤20 mg/day to 30 mg/day for 7 days in 16 patients with secondary adrenal insufficiency.ResultsIn healthy volunteers, 4 mg dexamethasone significantly increased peripheral blood mononuclear cell (PBMC) TSP1 mRNA levels (P<0.0001) and plasma TSP1 concentrations (P<0.0001), peaking at 12 h. Median (interquartile range) plasma TSP1 was higher in Cushing's, 638 (535–756) ng/ml, than in healthy volunteers, 272 (237–336) ng/ml (P<0.0001). Plasma TSP1 >400 ng/ml diagnosed Cushing's syndrome with sensitivity of 100% and specificity of 85%. The higher hydrocortisone dose increased plasma TSP1 from 139 (86–199) to 256 (133–516) ng/ml, (P<0.01) in patients with secondary adrenal insufficiency.ConclusionsTSP1 is a glucocorticoid responsive protein in humans. Further research is required to determine if plasma TSP1 has a role as a glucocorticoid biomarker.

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