Prevalence of Clinical Iatrogenic Cushing’s Syndrome and its Contributing Factors in Patients with Chronic Obstructive Airway Disease

Document Type : Original Article

Authors

Department of Pulmonary Medicine, Himalayan Institute of Medical Sciences, SRHU, Jolly Grant, Dehradun, India.

Abstract

Introduction: Iatrogenic Cushing’s syndrome develops due to chronic exposure to excess glucocorticoids and is associated with increased morbidity and mortality if it remains unrecognized and untreated. Cushing’s syndrome resulting from long-term use of exogenous glucocorticoids is the commonest cause of iatrogenic Cushing’s syndrome. In India, cases of iatrogenic Cushing’s syndrome are commonly encountered, owing to the steroid abuse for respiratory conditions and chronic pains along with poor access to health care.
Method and materials: This study was conducted in the Department of Respiratory Medicine, Himalayan Institute of Medical Science (HIMS), Swami Ram Nagar, Dehradun. Over a period of 12 months, subjects were recruited from the patients presenting to HIMS, Dehradun” with the primary diagnosis of obstructive airway disease after taking written informed consent.
Result: After a detailed history and examination and applying the inclusion and exclusion criteria, 384 consecutive patients diagnosed with Obstructive airway “disease were enrolled. Demographic data was recorded. Diagnosis of Iatrogenic Cushing syndrome was made on the basis of history of use of glucocorticoids and clinical examination. Most of the patients in the study population were   > 60 years of age (34.29%) There was a male predominance in our study with 243 (63.28%) males and 141 (36.72%) females. Smoking was the major risk factor for COPD in comparison to biomass fuel, present in 85.05% and 15.95%, of patients respectively.
Conclusion: In our study, prevalence of iatrogenic Cushing syndrome in obstructive airway disease was 7.81%. This study highlights role of screening for iatrogenic Cushing syndrome in patients with obstructive airway disease with early intervention to prevent the side effects of chronic indiscriminate use of steroids.

Keywords

References

  1. Howlett TA, Rees LH, Besser GM. Cushing's syndrome. Clinics in endocrinology and metabolism. 1985 Nov 1;14(4):911-45.
  2. Shah NS, George J, Acharya SV, Lila AR, Sarathi V, Bandgar TR, et al. Cushing disease in children and adolescents: twenty years’ experience in a tertiary care center in India. Endocrine Practice. 2011 May 1;17(3):369-76.
  3. Findling JW, Raff H. Cushing’s syndrome: important issues in diagnosis and management. The Journal of Clinical Endocrinology & Metabolism. 2006 Oct 1;91(10):3746-53.
  4. Newell‐Price J, Trainer P, Perry L, Wass J, Grossman A, Besser M. A single sleeping midnight cortisol has 100% sensitivity for the diagnosis of Cushing's syndrome. Clinical endocrinology. 1995 Nov;43(5):545-50.
  5. Newell-Price J, Bertagna X, Grossman AB, Nieman LK. Cushing's syndrome. The Lancet. 2006 May 13;367(9522):1605-17.
  6. Wood PJ, Barth JH, Freedman DB, Perry L, Sheridan B. Evidence for the low dose dexamethasone suppression test to screen for Cushing's syndrome—recommendations for a protocol for biochemistry laboratories. Annals of clinical biochemistry. 1997 May;34(3):222-9.
  7. Jeyaraman K, Ammini AC, Nandita G, Dwivedi SN. Late-night salivary cortisol in normal subjects and in patients with Cushing's syndrome. Postgraduate medical journal. 2010 Jul 1;86(1017):399-404.
  8. Catargi B, Rigalleau V, Poussin A, Ronci-Chaix N, Bex V, Vergnot V, Gin H, Roger P, Tabarin A. Occult Cushing’s syndrome in type-2 diabetes. The Journal of Clinical Endocrinology & Metabolism. 2003 Dec 1;88(12):5808-13.
  9. Leibowitz G, Tsur A, Chayen SD, Salameh M, Raz I, Cerasi E, et al. Pre‐clinical Cushing's syndrome: an unexpected frequent cause of poor glycaemic control in obese diabetic patients. Clinical endocrinology. 1996 Jun;44(6):717-22.
  10. Pivonello R, Faggiano A, Lombardi G, Colao A. The metabolic syndrome and cardiovascular risk in Cushing's syndrome. Endocrinology and Metabolism Clinics. 2005 Jun 1;34(2):327-39.
  11. Papanicolaou DA, Yanovski JA, Cutler GB Jr. A single midnight Journal, Indian Academy of Clinical Medicine. 2013;14:3-4.
  12. Papanicolaou DA, Yanovski JA, Cutler Jr GB, Chrousos GP, Nieman LK. A single midnight serum cortisol measurement distinguishes Cushing’s syndrome from pseudo-Cushing states. The Journal of Clinical Endocrinology & Metabolism. 1998 Apr 1;83(4):1163-7.
  13. Reimondo G, Allasino B, Bovio S, Paccotti P, Angeli A, Terzolo M. Evaluation of the effectiveness of midnight serum cortisol in the diagnostic procedures for Cushing’s syndrome. European journal of endocrinology. 2005 Dec 1;153(6):803-9.
  14. Decramer M, Stas KJ. Corticosteroid-induced myopathy involving respiratory muscles in patients with chronic obstructive pulmonary disease or asthma. American Review of Respiratory Disease. 1992 Sep 1;146:800-2.
  15. Venkateshwar A, prasad K, Gandiah P. Iatrogenic cushing syndrome-observation study.IJCMR:2017;22
  16. Singh Y, Kotwal N, Menon AS. Endocrine hypertension–Cushing's syndrome. Indian journal of endocrinology and metabolism. 2011 Oct;15(Suppl4):S313.
  17. Srivastav S, Ahmad S, Dhar M, Garg AK. Iatrogenic Cushing’s syndrome – An observasional study. Indian Academy of Clinical Medicine. 2015;16(1):43-46.
Journal of Cardio-Thoracic Medicine
Volume 9, Issue 4
December 2021
Pages 884-890

Files

Share

How to cite

Statistics