Outbreak of exogenous Cushing's syndrome due to unlicensed medications

Azizi, Fereidoun; Jahed, Seyed Adel; Lankarani, Mahnaz; Bejestani, H Shahrad; Esfahanian, Fatemeh; Beyraghi, Narges; Noroozi, Azita; Kobarfard, Farzad

doi:10.1111/j.1365-2265.2008.03290.x

Cited by 17 publications

(20 citation statements)

References 18 publications

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“…The systemic and musculoskeletal complications of Temgesic abuse imposed a heavy burden on the healthcare system in the recent years (4,5). This drug has been widely abused as a result of its low cost and its ability to mask the typical malnourished appearance of opium-dependent patients.…”

Section: Discussionmentioning

confidence: 99%

“…This drug has been widely abused as a result of its low cost and its ability to mask the typical malnourished appearance of opium-dependent patients. Temgesic vials contain corticosteroids and almost all abusers have signs of hypercortisolism, such as striae on their abdominal skin (4). Biochemical studies revealed that the available product in Iran consists of diacetylmorphine, acetylcodeine, pheniramine and heroin (4,5,15).…”

Section: Discussionmentioning

confidence: 99%

“…Temgesic vials contain corticosteroids and almost all abusers have signs of hypercortisolism, such as striae on their abdominal skin (4). Biochemical studies revealed that the available product in Iran consists of diacetylmorphine, acetylcodeine, pheniramine and heroin (4,5,15). As each vial contains 0.4mg Dexamethasone (4), patients of the present study had received an average of 767 mg (ranged 299 to 1792) Dexamethasone by the time of pain onset, which is equivalent to 5061 mg (ranged 1973 to 11827) of prednisone (16).…”

Section: Discussionmentioning

confidence: 99%

“…Literature concurs that without treatment, most hips affected by ONFH ultimately fail and need a salvage surgery (4). This finding accentuates the necessity of timely intervention to preserve the hip, since few hip preserving interventions are available after collapse (1).…”

Section: Introductionmentioning

confidence: 99%

“…Of note, there has been an increased incidence of osteonecrosis in drug abusers in Iran following the introduction of "Temgesic" to the illicit market several years ago (4). Temgesic is a combination of opioid and steroid medications and is used intravenously (5).…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated With the Course of Femoral Head Osteonecrosis; A Retrospective Study

Abolghasemian¹,

Shirazi²,

Gharanizadeh³

et al. 2015

Shafa Ortho J

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Background: An increased incidence of osteonecrosis of the femoral head (ONFH) has recently been observed in Iran, likely associated with the introduction of an illegal, steroid-containing opioid drug, Temgesic. The correlation of risk factors associated with the course of ONFH has yet to be determined. Objectives: The purpose of the present study was to assess the effects of etiologic factors on the course of ONFH after emergence of symptoms. Patients and Methods:We retrospectively assessed patients with untreated ONFH due to one of the four etiologies of steroid medication, Temgesic abuse, trauma and idiopathic. Patients with multiple risk factors and those without collapse at the last follow-up visit were excluded. The effect of age, gender, etiology of osteonecrosis, opium addiction and smoking on the time interval between pain onset and radiologic collapse were investigated. Results: In total, 110 patients (174 hips) were categorized into four etiologic groups. The average time between onset of pain to radiologic collapse in different etiologic groups was 12.8 months for all groups, 12.4 months for steroid, 8.7 months for Temgesic, 18.5 months for trauma and 16.6 months for idiopathic groups. Thirteen hips had collapse in less than six months. Patients who used steroid and Temgesic had shorter time interval to collapse, which was statistically significant (P Values < 0.001 and < 0.001, respectively). Smoking had a statistically significant association with the time to femoral head collapse (P Value = 0.003). Conclusions: Steroid medications and Temgesic abuse are associated with shorter time interval to femoral head collapse. Smoking is also a factor associated with shorter time interval to collapse. These factors should be considered in any joint preserving treatments for patients with FHON.

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Section: Discussionmentioning

confidence: 99%