Constellation of signs and symptoms caused by chronic glucocorticoid (steroid) excess, from excessive secretion or,
more commonly, from chronic glucocorticoid therapy.
Causes
- Iatrogenic (steroid treatment)
- Cushing’s Disease
- Adrenal adenoma, adrenal carcinoma
Clinical Features
- Central (truncal) obesity, moon face, buffalo hump
- Thinning of the skin, striae
- Poor wound healing, muscle weakness and atrophy
- Hirsutism and acne (females)
- Hypertension and hyperglycaemia
Differential diagnosis
- Ordinary obesity
- Alcoholism (alcohol-induced pseudo-Cushing’s syndrome)
Investigations
- Drug history
- Refer to higher level for hormonal tests (dexamethasone suppression test) if no history of steroid overuse
Management
Iatrogenic
- Slowly decrease steroid dose by 2.5-5 mg every 1 to 2 weeks
Non-iatrogenic
- Refer non-iatrogenic Cushing’s, or iatrogenic cases with complications to higher level of care