New case report highlights Cushing’s syndrome after yearlong steroid use
Prolonged, unsupervised steroid use led to serious complications
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A 20-year-old man developed exogenous, or therapy-related, Cushing’s syndrome after taking a high-dose steroid on his own for more than a year to treat autoimmune alopecia, a form of hair loss, according to a case report.
The case “underscores the serious complications that can arise from steroid use,” the researchers wrote, and highlights the need for “patient education and multidisciplinary follow-up” to prevent complications.
The report, “Steroid treatment for alopecia: development of cushing’s syndrome during recovery – A clinical case report ,” was published in the Visual Journal of Emergency Medicine.
How prolonged steroid use can cause Cushing’s syndrome
Exogenous Cushing’s syndrome develops when the body is exposed to high levels of certain medications, usually glucocorticoid steroids, for a prolonged period. It differs from Cushing’s disease, which is caused by a tumor in the pituitary gland that produces excess adrenocorticotropic hormone (ACTH), prompting the body to make too much cortisol. Although steroids are commonly prescribed to treat inflammatory and autoimmune conditions, prolonged or high-dose use can lead to serious side effects that resemble Cushing’s disease.
Steroids affect a hormone control system linking the brain and the adrenal glands, known as the hypothalamic–pituitary–adrenal (HPA) axis. At high doses, steroids can suppress this system, causing the adrenal glands to reduce or stop producing cortisol — a hormone that helps the body respond to stress, illness, and inflammation. If steroids are reduced too quickly after long-term use, this suppression can lead to adrenal insufficiency. Long-term steroid use can also dampen the immune system, increasing the risk of infections.
This case report from Turkey described a 20-year-old man who developed iatrogenic (treatment-related) Cushing’s syndrome after self-prescribing methylprednisolone for more than a year to treat total alopecia. He initially took 64 mg of methylprednisolone after finding dosing information online. After two weeks, he reduced the dose to 16 mg and continued taking that amount for slightly more than a year without medical supervision.
Symptoms worsened after more than a year of steroid use
During this time, his hair regrew, but he also gained weight and developed pink-purple stretch marks on his skin, which he initially attributed to weight gain. In the week before going to the emergency department, he developed muscle weakness, difficulty maintaining his balance without using his hands for support, bone pain, tremors, and episodes of memory loss. After suspecting the symptoms might be linked to steroid use, he abruptly reduced his dose to 4 mg. Soon afterward, his cognitive skills and speech became noticeably worse.
On examination, doctors observed features consistent with Cushing’s syndrome, including widespread purple stretch marks, central weight gain with a rounded abdomen, fat accumulation over the upper back, and easy bruising. His blood pressure and heart rate were elevated. Blood tests showed elevated lactate dehydrogenase levels and mildly abnormal liver enzyme levels, consistent with steroid-related muscle damage, while other laboratory results were within normal limits.
He was diagnosed with exogenous Cushing’s syndrome attributed to long-term, unsupervised steroid use and was referred to an endocrinology specialist. There, his methylprednisolone dose was adjusted to 8 mg, with plans for close medical follow-up.
Overall, “this case highlights the serious complications of prolonged steroid use, including cognitive dysfunction, myopathy, and Cushing’s syndrome, emphasizing the importance of individualized treatment protocols and regular monitoring to minimize side effects,” the researchers concluded.
