Complications

Complications of Cushing syndrome include the following:

Osteoporosis
Increased susceptibility to infections
Hirsutism
Diabetes mellitus
Hypertension
Risk for adrenal crisis

Patients with Cushing syndrome due to exogenous steroid use are at risk for having an adrenal crisis if they do not receive stress dose steroids during acute illnesses. Untreated adrenal crises can lead to death.

High levels of exogenous glucocorticoids may mask the abdominal symptoms associated with catastrophic abdominal events such as perforated bowel.

Patient Education

Patients should be educated about adrenal crisis, sick day rules within the following year after exogenous glucocorticoids is stopped, and medical bracelet alert.

Instruction on specific medication use is indicated.

Questions

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Physical findings in Cushing syndrome.
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Table 1. Glucocorticoid Equivalencies^[13]

Table 1. Glucocorticoid Equivalencies ^[13]

Type	Drug	Dose	Relative Glucocorticoid Potency	Relative Mineralocorticoid Potency	Plasma Half-Life (mg)	Biologic Half-Life (h)
Short-acting	Cortisol	20	1.0	2	90	8-12
Short-acting	Hydrocortisone^‡	25	0.8	2	80-118	8-12
Intermediate-acting	Prednisone	5	4	1	60	18-36
	Prednisolone	5	4	1	115-200	18-36
	Triamcinolone	4	5	0	30	18-36
	Methylprednisolone	4	5	0	180	18-36
Long-acting	Dexamethasone	0.5	25-50	0	200	36-54
Long-acting	Betamethasone	0.6	25-50	0	300	36-54
Mineralocorticoid	Aldosterone	0.3	0	300	15-20	8-12
	Fludrocortisone	2	15	150	200	18-36
	Desoxycorticosterone acetate	0	0	20	70	…

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Author

Ha Cam Thuy Nguyen, MD Fellow, Department of Endocrinology, University of Pittsburgh Medical Center

Ha Cam Thuy Nguyen, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Medical Association, Endocrine Society

Disclosure: Nothing to disclose.

Coauthor(s)

Catherine Anastasopoulou, MD, PhD, FACE Associate Professor of Medicine, The Steven, Daniel and Douglas Altman Chair of Endocrinology, Sidney Kimmel Medical College of Thomas Jefferson University; Einstein Endocrine Associates, Einstein Medical Center

Catherine Anastasopoulou, MD, PhD, FACE is a member of the following medical societies: American Association of Clinical Endocrinologists, American Society for Bone and Mineral Research, Endocrine Society, Philadelphia Endocrine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Romesh Khardori, MD, PhD, FACP (Retired) Professor, Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Eastern Virginia Medical School

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, Endocrine Society

Disclosure: Nothing to disclose.

Acknowledgements

Gail K Adler, MD, PhD, Associate Professor of Medicine, Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School.

Disclosure: Nothing to disclose.

Susanna L Dipp, MD Fellow, Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School

Disclosure: Nothing to disclose

Don S Schalch, MD Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, University of Wisconsin Hospitals and Clinics

Don S Schalch, MD is a member of the following medical societies: American Diabetes Association, American Federation for Medical Research, Central Society for Clinical Research, and Endocrine Society

Disclosure: Nothing to disclose