Adrenal Suppression and Exogenous Cushing Syndrome After Inhaled and Topical Corticosteroids - Two Clinical Cases and Review of the Subject

Abstract

The undesirable endocrine effects associated with pharmacological therapy with corticosteroids administered orally or parenterally are well-known in medical practice. However, the degree of vigilance is lower when compartmental corticosteroids are used, and it is a widely held assumption that local glucocorticoids rarely produce adrenal insuffi ciency or exogenous Cushing syndrome. The two cases that we present here demonstrate the appearance of major adrenal suppression and Cushing exogenous syndrome after inadequate use of topical corticosteroids and, the combination of inhaled corticosteroids with nasal glucocorticoids, respectively. The following mini-review shows, from the endocrinologist point of view, the main aspects to be considered by practitioners who recommend local glucocorticoid treatments-i.e. inhaled, topical (cutaneous, oral, nasal, ophthalmic) or intraarticular-to prevent the occurrence of major endocrine syndromes that are met after corticosteroid therapy, tertiary adrenal insuffi ciency and exogenous Cushing syndrome.