Exogenous Cushing's syndrome secondary to intermittent high dose oral prednisone for presumed asthma exacerbations in the setting of multiple emergency department visits

Abstract

Glucocorticoid therapies are extensively used in a wide range of medical conditions including respiratory, allergic, inflammatory and autoimmune diseases. Inappropriate use of therapeutic doses of glucocorticoids can lead to many adverse effects including hypothalamic pituitary axis suppression and Cushing's syndrome. All forms of glucocorticoid delivery have the potential to cause Cushing's syndrome. Here we present a case of exogenous Cushing's syndrome resulting from recurrent use of intermittent high dose oral prednisone to treat asthma exacerbation in the emergency department. This case report highlights the importance of pharmacovigilance in emergency departments and ambulatory settings. The knowledge of pharmacokinetic properties, daily dosage, frequency and differences in individual steroid metabolism is crucial in preventing adverse effects related to excessive use of glucocorticoids. Keywords: Asthma, Cushing's syndrome, Prednisone