Cushing’s Syndrome Secondary to Steroid Abuse

Abstract

Introduction: Cushing’s syndrome, a rare endocrine disorder may result from exogenous administration of steroids. Case Report: E.P, 4 years old female presented to RSUTH at 3 years 7 months with complaints of speech delay and difficulty standing from sitting position. She had left convergent squint, Grade 3/6 systolic murmur and proximal muscle weakness. Initial diagnosis was ‘Duchenne muscular dystrophy and Acyanotic congenital heart disease’. Echocardiography revealed Atrial and Ventricular Septal Defects. Creatine kinase was normal. She was placed on tabs prednisolone, furosemide, spironolactone and physiotherapy; counselled and booked for follow-up in 2 weeks. She defaulted from follow-up and continued to give Prednisolone. Five months later, she presented to the Cardiology clinic with excessive weight gain and breast development. She had moon face, truncal obesity, and elevated BP. She was referred to the Endocrinology clinic where, in addition, cushingoid appearance, hirsutism, acanthosis nigracans, a hump, striae, with a left convergent squint were noted. Breast was Tanner stage 2. Diagnosis was Cushing’s syndrome secondary to Steroid Abuse, Stage 2 hypertension, Premature thelarche? Diabetes mellitus? Pituitary tumour. Brain MRI and abdominal USS were normal. HbA1c was elevated, insulin, C-peptide and Adrenocorticotropic hormone (ACTH) levels were reduced. Other hormonal indices were normal. She was given tabs Amlodipine and Prednisolone stopped. She steadily improved. Six months later, her blood pressure and sugar had normalized. Conclusion: Cushing’s syndrome though rare may occur secondary to steroid abuse. Strict compliance to doctor’s prescription and follow up cannot be over emphasized. Key words: Cushing’s, Syndrome, Steroid, Abuse