Induced Cushing Syndrome

In drug-induced Cushing syndrome, patients begin to exhibit many of the symptoms associated with the 

General Indication Allergic disorders Principal Desired of Glucocorticoids Decreased inflammation Examples of Specific Disorders Anaphylactic reactions, drug-induced allergic reactions, severe hay fever, serum sickness 

Collagen disorders Immunosuppression Acute rheumatic carditis, dermatomyositis, systemic lupus erythematosus 

Dermatologic disorders Decreased inflammation Alopecia areata, dermatitis (various forms], keloids, lichens, mycosis fungoides, pemphigus, psoriasis 

Gastrointestinal disorders Decreased inflammation Crohn disease, ulcerative colitis 

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Tsuruoka S, Sugimoto K, Fujimura A. Drug-induced Cushing syndrome in a patient with ulcerative colitis after betamethasone enema evaluation of plasma drug concentration. Ther Drug Monit 1998 20(4) 387-9. 

Measures for attenuating or preventing drug-Induced Cushing syndrome, (a) Use... 

Drug-Induced Cushing s Syndrome (ACTH-independent)—most common cause of Cushing s syndrome... 

Measures for Attenuating or Preventing Drug-induced Cushing s Syndrome... 

Children Children may be more susceptible to topical corticosteroid-induced hypothalamic-pituitary-adrenal (HPA) axis suppression and Cushing syndrome than adults because of a larger skin surface area to body weight ratio. 

Hillebrand-Haverkort ME, Prummel MF, ten Veen JH. Ritonavir-induced Cushing s syndrome in a patient treated with nasal fluticasone. AIDS 1999 13(13) 1803. 

Raised glucocorticoid plasma concentrations usually result, after 2 weeks, in the first signs of iatrogenic Cushing s syndrome. The characteristic symptoms can occur individually or in combination. Whereas in Cushing s disease or corticotropin-induced Cushing s... 

Cushing disease A specific form of Cushing syndrome, which is caused by an ACTH-secreting pituitary adenoma represents approximately 66 percent of all cases of Cushing syndrome. Because of structural similarities with melanocyte-stimulating hormone (MSH), excess ACTH from pituitary adenomas can induce dermal hyperpigmentation. 

Pseudo-Cushing syndrome Condition in which alcohol induces symptoms of Cushing syndrome without the tumor that leads to increased cortisol levels. 

Fhtients may require a lower dose of glucocorticoid than those with primary adrenal insufficiency. Some patients will only require glucocorticoid replacement temporarily, which can be discontinued after recovery of the HPA axis (e.g., drug-induced adrenal insufficiency, adrenal insufficiency following treatment for Cushing s syndrome). 

Treatment with steroids may initially evoke euphoria. This reaction can be a consequence of the salutary effects of the steroids on the inflammatory process or a direct effect on the psyche. The expression of the unpredictable and often profound effects exerted by steroids on mental processes generally reflects the personality of the individual. Psychiatric side effects induced by glucocorticoids may include mania, depression, or mood disturbances. Restlessness and early-morning insomnia may be forerunners of severe psychotic reactions. In such situations, cessation of treatment might be considered, especially in patients with a history of personality disorders. In addition, patients may become psychically dependent on steroids as a result of their euphoric effect, and withdrawal of the treatment may precipitate an emotional crisis, with suicide or psychosis as a consequence. Patients with Cushing s syndrome may also exhibit mood changes, which are reversed by effective treatment of the hypercortisolism. 

To summarize, comorbidities on which a manic syndrome can be superimposed include ADHD, ODD, conduct or pervasive developmental disorders, Tour-ette s syndrome, or medical conditions such as brain tumors, multiple sclerosis, temporal lobe seizures, human immune-deficiency syndrome (HIV), and endocri-nopathies such as hyperthyroidism and Cushing s syndrome (James and Javaloyes, 2001). Organic affective syndrome, a condition given separate designation in DSM I-IIIR, is now subsumed under mood disorder due to a general medical condition in DSM IV. Substance induced mood disorder has a similar due to. . . designation. 

Findlay CA, Macdonald JF, Wallace AM, Geddes N, Donaldson MD. Childhood Cushing s syndrome induced by betamethasone nose drops, and repeat prescriptions. BMJ 1998 317(7160) 739-40. 

Animals ex adrenal cortex (stress-, ACTH-induced) 4- synthesis in Addison s disease (sufferers Jane Austen, John F. Kennedy) T synthesis in Cushing s syndrome... 

Certaiu medicatious have beeu associated with au iucrease iu osteoporosis risk, particularly steroids and anticonvulsants. Steroid-induced osteoporosis arises due to use of glucocorticoids, analogous to Cushing s syndrome, and involving mainly the axial skeleton prednisone... 

Andres E, Vinzio S, Goichot B, Schhenger JL. Mitotane-induced febrile pancytopenia a first case report in paraneoplastic Cushing s syndrome. Eur J Endocrinol 2001 144(1) 81. 

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