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Outbreak of exogenous Cushing's syndrome due to unlicensed medications
Author(s) -
Azizi Fereidoun,
Jahed Adel,
Hedayati Mehdi,
Lankarani Mahnaz,
Bejestani Hadi Shahrad,
Esfahanian Fatemeh,
Beyraghi Nargues,
Noroozi Alireza,
Kobarfard Farzad
Publication year - 2008
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2008.03290.x
Subject(s) - cushingoid , medicine , dexamethasone , narcotic , cushing syndrome , buprenorphine , heroin , vial , substance abuse , corticosteroid , glucocorticoid , endocrinology , drug , anesthesia , pharmacology , psychiatry , opioid , chemistry , receptor
Summary Objective Despite the widespread medical use of glucocorticoids, reports of factitious administration of these hormones have been uncommon. We herein report an outbreak of Cushing's syndrome in Tehran among the addicts using Tamgesic (a brand of Buprenorphine) to help them through the narcotic withdrawal stage, without knowledge of the glucocorticoid content of the black‐market drug. Design and measurements Case histories of 19 patients with a final diagnosis of iatrogenic Cushing's syndrome were reviewed. Liquid chromatography/mass spectrometry (LC–Mass) method was used to evaluate glucocorticoid existence in the brand. High performance liquid chromatography was used to determine plasma dexamethasone level. Results No buprenorphine was present in the vials. Each Tamgesic vial contained 0·4 mg of Dexamethasone disodium phosphate; Heroin was also found in them. The duration of injection abuse and the total dexamethasone intake was 4·5 (1–18) months and 2·6 (0·8–8) mg/day, respectively. Median plasma dexamethasone concentration was 5·8 nmol/l, with a range of 5–8·7. Physical findings of the cases were not different from those of the classic endogenous Cushing's syndrome but their serum cortisol and urinary free cortisol were suppressed. Severe life‐threatening complications were demonstrated in five cases. Conclusion Surreptitious use of steroids resulting in Cushing's syndrome may be more common in opium addicts; a high degree of suspicion is needed to uncover this disorder. Whenever facing a cushingoid appearance in addicts, the possibility of using black market drugs with corticosteroid contents should be kept in mind.