Iatrogenic Cushing's Syndrome with Inhaled Steroids

Main Article Content

Neha Nagare
Nikam Balkrishna
Jamale Varsha

Abstract

Long-term usage of exogenous corticosteroids is linked to the uncommon but severe adverse impact known as iatrogenic Cushing's syndrome. For the treatment of respiratory disorders like asthma and chronic obstructive pulmonary disease (COPD), inhaled corticosteroids (ICS) are frequently given. With regard to iatrogenic Cushing's syndrome specifically associated with the use of inhaled steroids, this review paper seeks to offer a thorough analysis.


ICS works by modulating the transcription of genes that promote inflammation, which reduces airway inflammation and improves respiratory symptoms. The risk of iatrogenic Cushing's syndrome can, however, increase as a result of increased exposure to corticosteroids caused by systemic absorption of ICS.


Due to underdiagnosis and underreporting, the prevalence of iatrogenic Cushing's syndrome with ICS treatment may be underestimated. Its development is influenced by a number of risk factors, such as high-dose ICS therapy, protracted treatment, and individual vulnerability.


Iatrogenic Cushing's syndrome caused by inhaled steroids presents clinically similarly to endogenous Cushing's disease, making diagnosis difficult. For a precise diagnosis, close observation, hormonal evaluations, and imaging modalities are necessary.


The goal of management is to address the underlying respiratory condition while reducing or stopping corticosteroid therapy. Effective management requires regular patient monitoring, dose titration, and alternate therapy choices. Additionally, precautionary precautions and approaches to reduce the chance of getting iatrogenic Cushing's syndrome from using ICS should be taken into account.


Iatrogenic Cushing's syndrome is a serious issue connected to the usage of inhaled steroids, to sum up. To ensure early discovery and effective care, clinicians should be aware of this potential risk and regularly follow patients.

Article Details

How to Cite
Nagare, N. ., Balkrishna, N. ., & Varsha, J. . (2023). Iatrogenic Cushing’s Syndrome with Inhaled Steroids. Journal of Coastal Life Medicine, 11(2), 50–55. Retrieved from https://www.jclmm.com/index.php/journal/article/view/897
Section
Articles

References

Loriaux DL. Diagnosis and differential diagnosis of Cushing's syndrome. N Engl J Med. 2017;376(15):1451-1459.

Guignat L, Bertherat J. The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline: commentary from a European perspective. Eur J Endocrinol. 2010;163(1):9-13. doi:10.1530/EJE-09-0627.

Kharaba Z, Feghali E, El Husseini F, et al. An Assessment of Quality of Life in Patients With Asthma Through Physical, Emotional, Social, and Occupational Aspects. A Cross-Sectional Study. Front Public Health. 2022;10:883784. Published 2022 Sep 1. doi:10.3389/fpubh.2022.883784.

Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. Updated 2021. Accessed October 10, 2021. https://ginasthma.org/gina-reports/

Barnes PJ. Inhaled corticosteroids. Pharmaceuticals (Basel). 2010;3(3):514-540.

Boulet LP, FitzGerald JM, Reddel HK. The revised 2014 GINA strategy report: opportunities for change. Curr Opin Pulm Med. 2015;21(1):1-7.

Marwick JA, Caramori G, Stevenson CS, et al. Inhibition of PI3Kδ restores glucocorticoid function in smoking-induced airway inflammation in mice. Am J Respir Crit Care Med. 2009;179(7):542-548.

Adcock IM, Ito K, Barnes PJ. Glucocorticoids: effects on gene transcription. Proc Am Thorac Soc. 2004;1(3):247-254.

Bhavsar P, Hew M, Khorasani N, et al. Relative corticosteroid insensitivity of alveolar macrophages in severe asthma compared with non-severe asthma. Thorax. 2008;63(9):784-790.

Djukanović R, Wilson SJ, Kraft M, et al. Effects of treatment with anti-immunoglobulin E antibody omalizumab on airway inflammation in allergic asthma. Am J Respir Crit Care Med. 2004;170(6):583-593.

Lipworth BJ. Systemic adverse effects of inhaled corticosteroid therapy: a systematic review and meta-analysis. Arch Intern Med. 1999;159(9):941-955.

Derendorf H, Möllmann H, Grüner A, et al. Pharmacokinetics and pharmacodynamics of inhaled corticosteroids. J Allergy Clin Immunol. 1998;101(4 Pt 2):S440-S446.

Usmani OS, Biddiscombe MF, Barnes PJ. Regional lung deposition and bronchodilator response as a function of beta2-agonist particle size. Am J Respir Crit Care Med. 2005;172(12):1497-1504.

Pedersen S, O'Byrne P. A comparison of the efficacy and safety of inhaled corticosteroids in asthma. Allergy. 1997;52(39 Suppl):1-34.

Dolovich MB, Dhand R. Aerosol drug delivery: developments in device design and clinical use. Lancet. 2011;377(9770):1032-1045.

Rhen T, Cidlowski JA. Antiinflammatory action of glucocorticoids—new mechanisms for old drugs. N Engl J Med. 2005;353(16):1711-1723.

Chen Cardenas SM, Santhanam P, Morris-Wiseman L, Salvatori R, Hamrahian AH. Perioperative Evaluation and Management of Patients on Glucocorticoids. J Endocr Soc. 2022;7(2):bvac185. Published 2022 Dec 2. doi:10.1210/jendso/bvac185.

Ramamoorthy S, Cidlowski JA. Corticosteroids: Mechanisms of Action in Health and Disease. Rheum Dis Clin North Am. 2016;42(1):15-vii. doi:10.1016/j.rdc.2015.08.002.

Pivonello R, De Martino MC, De Leo M, et al. Cushing's syndrome. Endocrinol Metab Clin North Am. 2018;47(2):313-334.

Nieman LK, Biller BM, Findling JW, et al. The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008;93(5):1526-1540.

Yasir M, Goyal A, Sonthalia S. Corticosteroid Adverse Effects. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK531462/.

Vilar L, Freitas Mda C, Faria M, et al. Pitfalls in the diagnosis of Cushing's syndrome. Arq Bras Endocrinol Metabol. 2007;51(8):1207-1216. doi:10.1590/s0004-27302007000800006.

Boscaro M, Arnaldi G. Approach to the patient with possible Cushing's syndrome. J Clin Endocrinol Metab. 2009;94(9):3121-3131.

Nutting CM, Page SR. Iatrogenic Cushing's syndrome due to nasal betamethasone: a problem not to be sniffed at!. Postgrad Med J. 1995;71(834):231-232. doi:10.1136/pgmj.71.834.231

Cranmer LM, Kanyugo M, Jonnalagadda SR, et al. High prevalence of tuberculosis infection in HIV-1 exposed Kenyan infants. Pediatr Infect Dis J. 2014;33(4):401-406. doi:10.1097/INF.0000000000000124