Iatrogenic Cushing syndrome is a side effect of glucocorticoid medications or glucocorticoid-containing products. It can cause many problems like obesity, fragile bones, and thinning skin.

Cushing syndrome is a condition characterized by elevated levels of the hormone cortisol that can cause problems like obesity and easy bruising. It’s divided into two main types:

Endogenous Cushing syndrome is when your adrenal glands produce too much cortisol. Exogenous Cushing syndrome is when your symptoms are caused by factors outside your body.

Iatrogenic Cushing syndrome is the most common type of exogenous Cushing syndrome. It develops in people who are taking high levels of glucocorticoid medications, which are commonly prescribed to treat autoimmune and inflammatory conditions. These medications act like cortisol in your body.

Read on to learn more about iatrogenic Cushing syndrome, including risk factors, symptoms, and treatment options.

Iatrogenic Cushing syndrome is the most common form of Cushing syndrome. It’s caused by taking glucocorticoid medications, such as:

Glucocorticoids are often prescribed to treat autoimmune or inflammatory diseases, such as:

Some herbal products can also cause iatrogenic Cushing syndrome. For example, in a 2022 case study, a 49-year-old woman and a 61-year-old woman received a diagnosis of Cushing syndrome while taking Artri King, which was reported to contain undisclosed glucocorticoids.

Cushing syndrome can cause many characteristic signs and symptoms, such as:

Compared with people with endogenous Cushing syndrome, iatrogenic Cushing syndrome tends to cause more striking symptoms.

Left untreated, Cushing syndrome can cause many complications, such as:

It’s important to see a doctor if you have potential symptoms of Cushing syndrome, especially if you’re taking glucocorticoids. It’s important not to stop taking your medications unless a doctor tells you to. Rapidly stopping glucocorticoid use can cause side effects like:

A doctor may suspect Cushing syndrome if you have characteristic signs and symptoms of the disease. They’re especially likely to suspect Cushing syndrome if you’re taking glucocorticoids.

To make a diagnosis, a doctor might:

  • perform a physical exam
  • ask you about your symptoms
  • review your personal and family medical history
  • order lab tests

Some of the lab tests you may receive include:

  • Twenty-four hour urinary free-cortisol test: You’ll collect urine samples for 24 hours so they can be tested for higher than normal cortisol levels.
  • Late night salivary cortisol test: You’ll collect a sample of your saliva at night so it can be tested for high cortisol levels in a lab.
  • Low dose dexamethasone suppression test: You’ll be given a low dose of the glucocorticoid dexamethasone around 11 p.m. You’ll have blood taken the next morning to see if your cortisol levels dropped. Sometimes, you receive dexamethasone every 6 hours for 48 hours and receive a blood test 6 hours after your last dose.
  • Dexamethasone corticotropin-releasing hormone (CRH) test: The dexamethasone-CRH test can help identify if Cushing syndrome or another condition is causing your high cortisol. During the test, you’ll receive an injection of CRH and oral dexamethasone. High cortisol levels before your CRH injection or increasing levels through the test suggest Cushing syndrome.

The best treatment for iatrogenic Cushing syndrome is to taper the use of glucocorticoids. A doctor can help you determine how much and how quickly you can lower your dose. Lowering your dose too quickly can cause glucocorticoid withdrawal.

It can take several months for your adrenal gland function to completely return to normal after lowering or ceasing your dose of glucocorticoids. Without treatment, Cushing syndrome can lead to fatal complications and even death.

Some of the leading causes of death are:

Iatrogenic Cushing syndrome is caused by glucocorticoid medications. You may be able to prevent Cushing syndrome by:

  • taking your medications as prescribed
  • avoiding exceeding your prescribed dose
  • avoiding herbal products linked to elevated cortisol
  • speaking with a doctor if you develop any side effects

Here are some frequently asked questions people have about iatrogenic Cushing syndrome.

What is a pseudo-Cushing syndrome?

Pseudo-Cushing syndrome is when a person develops high cortisol levels without a problem with their glands and without contacting glucocorticoid-containing products. Potential causes include:

What are iatrogenic Cushing syndrome cortisol levels?

Cortisol levels higher than 1.8 milligrams per deciliter of blood on a dexamethasone suppression test suggests Cushing syndrome.

What is the life expectancy of someone with Cushing syndrome?

Cushing syndrome can lead to life threatening complications if it’s not treated. In a 2022 Swedish study, researchers found that the risk of death was 2.1 times higher among people with Cushing disease than people in the general population at a median follow-up period of 10.6 years.

Iatrogenic Cushing syndrome is best treated by tapering off glucocorticoids. It’s important to follow a doctor’s instructions about how quickly you can lower your medication because stopping too quickly can lead to withdrawal.