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iatrogenic cushing syndrome

Antonella Guarino, Luisa Di Benedetto, Valentina Giovanale, Gian Luca Rampioni Vinciguerra, Antonella Stoppacciaro, Filippo Bellati, Donatella Caserta
Most frequent causes of androgenic manifestation are Cushing's syndrome, PCO, benign and malignant androgen-secreting non adrenal tumors and iatrogenic hirsutism. Hyperplasia or neoplasms of ectopic adrenocortical gland are rare. We report a case of a 63-year old female with hirsutism and alopecia. Laboratory data highlighted increased levels of androgens. Diagnostic imaging revealed normal morphology of adrenocortical gland and ovaries. In view of the clinical picture and suspected diagnosis of extra-adrenal cause, she underwent bilateral salpingo-oophorectomy...
January 19, 2017: Gynecological Endocrinology
Joel J Heidelbaugh
Hirsutism is defined as excessive terminal hair growth, such as coarse sexual or secondary hair, that typically appears in a male growth pattern in androgen-dependent areas of the female body. It can occur in men and women. Common etiologies include polycystic ovary syndrome, idiopathic hyperandrogenemia, idiopathic hirsutism, adrenal hyperplasia due to 21-hydroxylase deficiency, androgen-secreting tumors, iatrogenic hirsutism, acromegaly, Cushing syndrome, hyperprolactinemia, and hypo- or hyperthyroidism. Diagnostic guidelines are predominantly aimed at premenopausal women but an appropriate evaluation for underlying endocrinopathies in postmenopausal women and men may be required...
December 2016: FP Essentials
Joseph M Pappachan, Harit N Buch
Elevated blood pressure resulting from few endocrine disorders (endocrine hypertension) accounts for a high proportion of cases of secondary hypertension. Although some features may be suggestive, many cases of endocrine hypertension remain silent until worked up for the disease. A majority of cases result from primary aldosteronism. Other conditions that can cause endocrine hypertension are: congenital adrenal hyperplasia, Liddle syndrome, pheochromocytomas, Cushing's syndrome, acromegaly, thyroid diseases, primary hyperparathyroidism and iatrogenic hormone manipulation...
November 19, 2016: Advances in Experimental Medicine and Biology
Sern Wei Yeoh
Direct acting antiviral (DAA) regimens containing ritonavir have been developed to treat hepatitis C, with fewer side effects than that by interferon-based regimens. However prescribers must be aware of drug-drug interactions. There are multiple reports of iatrogenic Cushing syndrome (CS) caused by ritonavir, when used to treat human immunodeficiency virus, increasing the bioavailability of exogenous steroids by inhibiting cytochrome p450 enzymes in the liver and gut wall and thus reducing steroid metabolism...
September 2016: Journal of Clinical and Experimental Hepatology
Emilie R Elliot, Aikaterini Theodoraki, Lakshmi R Jain, Neal J Marshall, Marta Boffito, Stephanie E Baldeweg, Laura J Waters
Ritonavir and cobicistat, used as pharmacokinetic enhancers in combination with some antiretrovirals (ARVs) for the treatment of HIV, are potent inhibitors of the CYP3A4 isoenzyme. Most glucocorticoids are metabolised via the CYP3A4 pathway and iatrogenic Cushing's syndrome (ICS), with possible secondary adrenal insufficiency (SAI), is a recognised complication following co-administration with ritonavir or cobicistat. A structured approach for identifying and managing potentially affected individuals has not been established...
October 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
Laura E Dichtel, Melanie Schorr, Corey M Gill, Konstantinos P Economopoulos, Anu V Gerweck, Brooke Swearingen, Richard Hodin, Miriam A Bredella, Karen K Miller
No abstract text is available yet for this article.
January 2017: Clinical Endocrinology
Betty P Messazos, Margaret R Zacharin
No abstract text is available yet for this article.
December 2016: Journal of Paediatrics and Child Health
Y-T Huang, C-H Liao, P-R Hsueh
No abstract text is available yet for this article.
June 2016: British Journal of Dermatology
Sarah Orton, Marisa Censani
Iatrogenic Cushing's syndrome (ICS) is caused by exogenous corticosteroid administration with suppression of the hypothalamic-pituitary-adrenal axis. It has been commonly described with oral and topical steroid use, but scarce reports have documented intranasal steroid usage as the etiology in infancy. In this article, we describe a case of a 4-month-old infant who developed ICS after 6 weeks of intranasal dexamethasone ophthalmic solution administration for nasal obstruction. To our knowledge, this is the youngest patient reported with ICS due to intranasal use of a prescribed dose of an ophthalmic steroid...
May 2016: Pediatrics
Birsen Sahıp, Mehmet Celık, Semra Ayturk, Ahmet Kucukarda, Onur Mert, Nejla Dıncer, Sıbel Guldıken, Armagan Tugrul
Glucocorticoids are used for the treatment of many diseases, such as inflammatory, allergic, autoimmune, and neoplastic diseases. They can be used in the form of topical, oral, inhalable, rectal, and intra-articular agents. Many topical steroid-related iatrogenic Cushing's syndrome cases affecting especially children have been reported in the literature. Topical steroid-related Cushing's syndrome is rarely seen in adults. In this report, we present the case of a 32-year-old male patient with iatrogenic Cushing's syndrome related to long-term clobetasol propionate treatment for psoriasis...
January 2016: Indian Journal of Dermatology
Dan Louie Renz P Tating, Natasha Denise S Montevirgen, Loyda Cajucom
Cushing's syndrome is a state of cortisol excess, possibly from a tumor in the pituitary gland, the adrenal gland, or an ectopic nonpituitary ACTH-secreting source. The first form, pituitary in origin, was originally described by Harvey Cushing, MD, and was labeled as Cushing's disease. Long-term therapy with glucocorticoids also can lead to iatrogenic Cushing's syndrome.
March 2016: Oncology Nursing Forum
Adam Maciejewski, Angelika Stellmach, Katarzyna Łącka
Cushing's syndrome (CS) is relatively rare disorder affecting 2-5 per million per year, although the issue of establishing the diagnosis of CS and differential diagnosis of the disease are a significant clinical problem. CS is usually the result of excessive exogenous glucocorticoids usage (iatrogenic CS), endogenous CS can be divided into ACTH-dependent and ACTH-independent. Regardless of its etiology, the most important steps in establishing the diagnosis of CS are taking careful history and examination. The symptoms with high discriminatory value are myopathy, reddish purple striae, easy bruising and plethora...
October 2015: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
Luísa Azevedo, Hugo Pêgo, Teresa Souto Moura, Isabel Germano
The advent of highly active antiretroviral therapy for HIV infection dramatically changed the landscape of the disease. Ritonavir, a protease inhibitor (PI) frequently used in low doses to 'boost' the concentrations of other PIs, inhibits the cytochrome P450 3A4 isoenzyme, a common metabolic pathway to multiple drugs, so the potential for drug interactions is not negligible. A 39-year-old man with HIV-1 infection, treated with a ritonavir-boosted PI, was started on fluticasone/salmeterol inhaler and intranasal fluticasone, in 2009, in the setting of asthma and allergic rhinitis...
2015: BMJ Case Reports
Miguel Debono, Ashwini Mallappa, Verena Gounden, Aikaterini A Nella, Robert F Harrison, Christopher A Crutchfield, Peter S Backlund, Steven J Soldin, Richard J Ross, Deborah P Merke
OBJECTIVES: The treatment goal in congenital adrenal hyperplasia (CAH) is to replace glucocorticoids while avoiding androgen excess and iatrogenic Cushing's syndrome. However, there is no consensus on how to monitor disease control. Our main objectives were to evaluate hormonal circadian rhythms and use these profiles to identify optimal monitoring times and novel disease biomarkers in CAH adults on intermediate- and long-acting glucocorticoids. DESIGN: This was an observational, cross-sectional study at the National Institutes of Health Clinical Center in 16 patients with classic CAH...
December 2015: European Journal of Endocrinology
Narendranath Epperla, Fergus McKiernan
Ritonavir is a potent inhibitor of the cytochrome P450 enzyme CYP3A4 and is subject to multiple drug-drug interactions. This becomes especially important when the patient is also taking medications metabolized through CYP3A pathway as increased and potentially toxic drug levels may ensue. Herein we present one such interaction wherein a 57 year old gentleman with human immunodeficiency virus (HIV) infection on highly active antiretroviral therapy that included ritonavir, had addition of fluticasone inhaler to his medication repertoire for treatment of chronic obstructive pulmonary disease...
2015: SpringerPlus
Sunil Karande
Home delivery, low birth weight babies and maternal illiteracy among the poor in rural India are frequent. The rural poor prefer to seek healthcare from private providers, most of whom have no formal medical training and buy medicines from private pharmacies without a prescription owing to a weakly regulated environment. This report is of a 4-month-old baby from a remote village in northern India, who presented with exogenous Cushing syndrome. This baby was a full-term low birth weight home delivery. As the baby was not growing well, treatment was started at 1 month by a private doctor with betamethasone drops The mother on her own volition continued giving the betamethasone drops by buying the medicine over the counter from a private pharmacy...
2015: BMJ Case Reports
Wiebren A A Tjalma
The present report describes the case of a woman diagnosed with an adrenocorticotropic hormone- (ACTH-) secreting thymic carcinoid associated with Cushing's syndrome. Treatment consisted of tumour resection and 131-I-meta-iodobenzylguanidine (MIBG) therapy. In spite of her iatrogenic menopausal state she twice became pregnant and delivered two healthy babies but developed recurrences during both pregnancies. The last recurrence presented as a primary breast cancer. Despite poor prognosis our patient survived for eleven years...
2015: Case Reports in Obstetrics and Gynecology
Pranab Kumar Sahana, Nilendu Sarma, Nilanjan Sengupta, Prashant Subhash Somani
Here we report a case of a young male who developed full blown iatrogenic Cushing's syndrome after use of superpotent clobetasol propionate cream 0.05% for long duration to suppress psoriatic skin lesions. He also developed osteoporosis and hypogonadism. This case demonstrates that injudicious use of topical steroids can have disastrous consequences.
July 2015: Indian Journal of Dermatology
Leticia Ortega-Evangelio, Javier Navarrete-Sanchis, Basil K Williams, Juan Miguel Tomas-Torrent
PURPOSE: We report a rare case of spontaneous eyeball luxation associated with exophthalmos due to iatrogenic Cushing syndrome (CS). The normalization of serum hormones led to the regression of the picture. CASE: A 64-year-old man presented with spontaneous globe luxation of the left eye after a 6-month history of bilateral, painless, and slowly progressive exophthalmos. The patient had been receiving weekly infusions of methylprednisone over the previous 6 months...
October 2015: Graefe's Archive for Clinical and Experimental Ophthalmology
C S Martin, C Blaga, I M Lambrescu, C Fierbințeanu-Braticevici, S Fica
WHAT IS KNOWN AND OBJECTIVE: Budesonide, an oral glucocorticoid indicated for the treatment of Crohn's disease, rarely interferes with the hypothalamic-pituitary-adrenal axis because more than 80% of it is metabolized by cytochrome P450 enzymes. CASE SUMMARY: A 33-year-old female patient diagnosed with Crohn's disease, treated with oral budesonide, was admitted for Cushingoid symptoms and signs. The onset coincided with the use of fluvoxamine, a serotonin reuptake inhibitor and also a potent inhibitor of cytochrome P450 enzymes that presumably led to budesonide accumulation...
August 6, 2015: Journal of Clinical Pharmacy and Therapeutics
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