[Treatment of iatrogenic Cushing syndrome: questions of glucocorticoid withdrawal]

Iatrogenic Cushing's Syndrome with Subsequent Adrenal Insufficiency in a Patient with Psoriasis Vulgaris Using Topical Steroids

Iatrogenic Cushing's syndrome (ICS) is usually related to prolonged and/or high-dose oral or parenteral steroid use. Psoriasis vulgaris (PV) is chronic inflammatory disease and characterized by periods of attack and remission. Topical steroid (TS) is the first choice of treatment for localized and mild PV. The development of systemic side effects of the steroids is usually not observed after TS application. But the risk of developing ICS still exists. In the literature, there are a few adult cases who developed ICS and subsequent adrenal insufficiency associated with TS. In this article, a male patient with PV developing ICS and secondary adrenal insufficiency after treatment of TS for 12 years is presented.

Iatrogenic Cushing's Syndrome After Topical Steroid Therapy for Psoriasis

Glucocorticoids are used for the treatment of many diseases, such as inflammatory, allergic, autoimmune, and neoplastic diseases. They can be used in the form of topical, oral, inhalable, rectal, and intra-articular agents. Many topical steroid-related iatrogenic Cushing's syndrome cases affecting especially children have been reported in the literature. Topical steroid-related Cushing's syndrome is rarely seen in adults. In this report, we present the case of a 32-year-old male patient with iatrogenic Cushing's syndrome related to long-term clobetasol propionate treatment for psoriasis. In the context of such treatment, the glucocorticoid withdrawal problem has to be overcome. At present there is no consensus on steroid withdrawal. Patients on long-term glucocorticoid treatment must be evaluated for potential adverse effects and withdrawal symptoms by their physician and their endocrinologist.

Cushing syndrome induced by parents: a report of two cases

Cushing syndrome developed in two children following inappropriate dosage and duration of corticosteroids by parents. One was a 7-year-old boy who was prescribed prednisolone for treatment of neurocysticercosis. The other was a 1-year-old boy who was prescribed oral betamethasone for a respiratory infection.

[Autoimmune pancreatitis]

Autoimmune pancreatitis is a rare form of chronic pancreatitis. Its clinical relevance, however, cannot be dismissed, as it can be difficult to distinguish autoimmune pancreatitis from malignant pancreatic cancer and in contrast with the majority of chronic pancreatitis forms it can be efficiently treated, even complete remission can be achieved on steroid therapy. The clinical picture of autoimmune pancreatitis is not characteristic, obstructive jaundice, abdominal pain, weight loss are frequently observed. Imaging studies often show diffuse pancreas enlargement and irregular narrowing of the main pancreatic duct. Elevated serum IgG4 immunoglobulin concentrations, some autoantibodies and the presence of IgG4 positive immune cells were observed in addition to other histological features. Apart from pancreatic manifestations, other organs may also be affected, thus associations with sclerosing cholangitis, sialoadenitis, retroperitoneal fibrosis, Riedel thyroiditis and inflammatory bowel diseases have been described. Based on these findings, autoimmune pancreatitis should be regarded as a systemic disease, as a manifestation of systemic IgG4-related sclerosing disease.

Neurological and psychiatric aspects of some endocrine diseases. The role of neurosteroids and neuroactive steroids

A neuroaktív szteroid bármely szervben képződik, módosítani képes a neurális aktivitást különböző membránreceptorok modulálása útján. A neuroszteroid de novo a neuronban és gliában szintetizálódik, a központi idegrendszerben megtalálhatók a szteroidképző enzimek. A citoplazmában klasszikus, genomikus úton szabályzó, hosszú idejű hatásokat kiváltó szteroidhormon-receptorok vannak, a membránban rövid időtartamú, nem klasszikus szteroidreceptorok. Lényeges szerepet játszanak a szteroidreceptorokkal interferáló vagy az aktivitásukat fokozó korepresszorok és koaktivátorok. A kortikoszteroidok a stresszben betöltött funkciójukon túl bizonyított szerepet játszanak a félelemben, szorongásban és memóriafunkciókban, így Cushing-szindrómában gyakran fordul elő hangulatzavar, reverzíbilis cerebrális atrófia a kognitív funkciók átmeneti csökkenésével, ritkábban delírium vagy pszichózis. A periféria részéről közismert a szteroid-myopathia. Az Addison-kórra izomgyengeség, energiacsökkenés, a mentális funkciók és az életminőség csökkenése jellemző. Az ösztrogén és progeszteron saját receptorral rendelkezik, az allopregnanolon a GABA-receptorokon keresztül fejti ki hatását. Alapvető szerepük van az agy fejlődésének, az idegkörök és dendritek architektúrájának, az axonkapcsolatok sűrűségének és a sejtszámnak az alakulásában. Befolyásolják a maturációt, neuroprotekciót, görcskészséget, a kognitív funkciókat, hangulatot, szorongást, fájdalmat és a perifériás idegek restitúcióját. Az androgéneknek is van kapcsolatuk a kognitív funkciókkal, fájdalommal, szorongással, hangulatzavarokkal, valamint az agresszivitással is.