Dexamethasone osteoporosis with

Oral glucocorticoids such as dexamethasone and prednisolone are still used in patients with severe asthma, though these agents are associated with adverse systemic effects such as growth retardation, osteoporosis, and the suppression of hypothalamic-pituitary adrenal function and the immune system. 

This patient presents with many of the classic findings of Cushing syndrome. Adrenal hyperplasia can be caused by excessive stimulation from ACTH (pituitary or ectopic production) or from a primary adrenal problem such as adenomas/ carcinomas. In addition to above symptoms, patients with Cushing syndrome are also at risk for osteoporosis and diabetes mellitus (DM). The diagnosis is confirmed with elevated cortisol levels after a dexamethasone suppression test. Treatment depends on the underlying etiology and is often surgical. 

A variety of debilitating diseases, such as rheumatoid arthritis, inflammatory myopathies, cancers, and a variety of immunological diseases are treated with the classic synthetic glucocorticoids, dexamethasone, and prednisone. However, long-term treatment with these drugs often leads to serious side effects such as fat redistribution, diabetes, vascular necrosis, and osteoporosis. There is currently an intense effort to identify new small molecules that are able to differentially modulate GR to retain the beneficial effects of glucocorticoids and reduce the incidence of unwanted side effects [10]. 

Cushing s S)mdrome State of excess glucocorticoids caused by 1) overmedication with drugs listed above, 2) adrenal hypersecretion due to tumor, or 3) excessive ACTH release (pituitary adenoma or metastatic tumors). Results in osteoporosis, skin atrophy, abnormal fat distribution, abnormal glucose tolerance, behavioral abnormalities, euphoria. Diagnosed by dexamethasone suppression test (Table 10.6). 

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