Steroid Induced Exogenous Cushing’s Syndrome with Biochemical Cortisol Suppression: a Clinical Case Report

Abstract

Cushing’s syndrome is an endocrine disorder caused by prolonged exposure to excess cortisol. Exogenous Cushing’s syndrome, the most common form, results from long-term glucocorticoid therapy, leading to suppression of the hypothalamic–pituitary–adrenal axis and reduced endogenous cortisol production. It is associated with significant metabolic, cardiovascular, and infectious complications. Common clinical features include central obesity, moon face, buffalo hump, thin skin, violaceous striae, proximal muscle weakness, hypertension, and hyperglycemia.

Case Presentation: A 70-year-old female with chronic obstructive pulmonary disease and hypothyroidism presented with cough, breathlessness, fever, and bilateral lower limb edema. Examination revealed hypertension, tachycardia, bilateral rhonchi, and Cushingoid features. Laboratory findings showed neutrophilia, altered thyroid profile, hypoproteinemia, and reduced serum cortisol levels, suggestive of hypothalamic–pituitary–adrenal axis suppression secondary to prolonged corticosteroid use, including inhaled beclomethasone. She was managed with antibiotics, systemic corticosteroids, bronchodilators, insulin, antihypertensives, diuretics, and supportive therapy, and improved clinically.

Case Discussion: The patient’s presentation was consistent with exogenous Cushing’s syndrome complicated by infective exacerbation of COPD and metabolic disturbances. Careful medication review and monitoring were essential for diagnosis and management.

Conclusion: Early recognition, detailed medication history, gradual steroid tapering, and regular monitoring are crucial to prevent complications and ensure safe long-term corticosteroid therapy.