Understanding the symptoms of Cushing's Syndrome by way of the adverse side effects of Prednisone.
My experience is that many patients never read or understand the labels, and sadly, neither do many medical professionals. My intention here is to make this page a resource for patients, family and medical professionals to have as a basis for discussion and should not be construed as medical advice. Most terms are linked with the Farlex Medical Dictionary.
Allergic Reactions
anaphylactoid or hypersensitivity reactions
Cardiovascular System
ECG changes caused by potassium deficiency
hypertension or aggravation of hypertension
hypertrophic cardiomyopathy in premature infants
myocardial rupture following recent myocardial infarction
necrotizing angiitis
pulmonary edema
syncope
tachycardia
thromboembolism
thrombophlebitis
vasculitis
Dermatologic
acne
acneiform eruptions
allergic dermatitis
alopecia
angioedema
angioneurotic edema
atrophy and thinning of skin
dry scaly skin
ecchymoses and petechiae
erythema
facial edema
hirsutism
impaired wound healing
increased sweating
Karposi’s sarcoma
lupus erythematosus-like lesions
perineal irritation
purpura
rash
striae
subcutaneous fat atrophy
suppression of reactions to skin tests
striae
telangiectasis
thin fragile skin
thinning scalp hair
urticaria
Endocrine
Adrenal insufficiency-greatest potential caused by high potency glucocorticoids with long duration of action (associated symptoms include; arthralgias, buffalo hump, dizziness, life-threatening hypotension, nausea, severe tiredness or weakness)
amenorrhea
postmenopausal bleeding or other menstrual irregularities
decreased carbohydrate and glucose tolerance
development of cushingoid state
diabetes mellitus (new onset or manifestations of latent)
glycosuria
hyperglycemia
hypertrichosis
hyperthyroidism
hypothyroidism
increased requirements for insulin or oral hypoglycemic agents in diabetics
lipids abnormal
moon face
negative nitrogen balance caused by protein catabolism
secondary adrenocortical and pituitary unresponsiveness
suppression of growth in pediatric patients
Fluid and Electrolyte Disturbances
congestive heart failure in susceptible patients
fluid retention
hypokalemia
hypokalemic alkalosis
metabolic alkalosis
hypotension or shock-like reaction
potassium loss
sodium retention with resulting edema
Gastrointestinal
abdominal distention
abdominal pain
anorexia which may result in weight loss
constipation
diarrhea
elevation in serum liver enzyme levels (usually reversible upon discontinuation)
gastric irritation
hepatomegaly
increased appetite and weight gain
nausea
oropharyngeal candidiasis
pancreatitis
peptic ulcer with possible perforation and hemorrhage
perforation of the small and large intestine (particularly in patients with inflammatory bowel disease)
ulcerative esophagitis
vomiting
Hematologic
anemia
neutropenia (including febrile neutropenia)
Metabolic
negative nitrogen balance due to protein catabolism
Musculoskeletal
arthralgias
aseptic necrosis of femoral and humeral heads
increase risk of fracture
loss of muscle mass
muscle weakness
myalgias
osteopenia
osteoporosis
pathologic fracture of long bones
steroid myopathy
tendon rupture (particularly of the Achilles tendon)
vertebral compression fractures
Neurological/Psychiatric
amnesia
anxiety
benign intracranial hypertension
convulsions
delirium
dementia (characterized by deficits in memory retention, attention, concentration, mental speed and efficiency, and occupational performance)
depression
dizziness
EEG abnormalities
emotional instability and irritability
euphoria
hallucinations
headache
impaired cognition
incidence of severe psychiatric symptoms
increased intracranial pressure with papilledema (pseudotumor cerebri) usually following discontinuation of treatment
increased motor activity
insomnia
ischemic neuropathy
long-term memory loss
mania
mood swings
neuritis
neuropathy
paresthesia
personality changes
psychiatric disorders including steroid psychoses or aggravation of pre-existing psychiatric conditions
restlessness
schizophrenia
verbal memory loss
vertigo
withdrawn behavior
Ophthalmic
blurred vision
cataracts (including posterior subcapsular cataracts)
central serous chorioretinopathy
establishment of secondary bacterial, fungal and viral infections
exophthalmos
glaucoma
increased intraocular pressure
optic nerve damage
papilledema
Other
abnormal fat deposits
aggravation/masking of infections
decreased resistance to infection
hiccups
immunosuppresion
increased or decreased motility and number of spermatozoa
malaise
insomnia
moon face
pyrexia
My own observations:
Livedo (either reticularis or racemosa)
It is of particular interest that Prednisone can induce vasculitis as it is also the standard of treatment for that disease, and in the event that a patient is on long term corticotherapy and exhibits signs of vasculitis, it becomes increasingly unlikely that it will be possible for them to wean off of this medication successfully. It is my belief that while classic steroid dementia syndrome is classified as a reversible dementia, that with further exploration, it will be found to be a mixed dementia consisting of both the reversible classic component, and the irreversible vascular component as would be found in Sneddon's Syndrome. This will typically appear in cases of lifetime corticotherapy where weaning is no longer possible.
The personality change listed in the neurological/Psychiatric adverse side effects is actually a shift towards psychopathy. This is supported by the work of Dr. Owen Wolkowitz who showed that excess glucocorticoids shrink hippocampal volume. A reduced hippocampal volume has a high correlation with psychopathic behavior. Interestingly, when the excess glucocorticoids are removed, such as after the surgical removal of a tumor causing Cushing's Disease, the hippocampal volume increases and the psychopathic behaviors and narcissistic behaviors decrease.
Finally, the simple definition of drug addiction as defined by the Mayo Clinic staff:
Drug addiction, also called substance use disorder, is a dependence on a legal or illegal drug or medication. Keep in mind that alcohol and nicotine are legal substances, but are also considered drugs.
When you're addicted, you're not able to control your drug use and you may continue using the drug despite the harm it causes. Drug addiction can cause an intense craving for the drug. You may want to quit, but most people find they can't do it on their own.
Drug addiction can cause serious, long-term consequences, including problems with physical and mental health, relationships, employment, and the law.
You may need help from your doctor, family, friends, support groups or an organized treatment program to overcome your drug addiction and stay drug-free.
This points out that continuing to take a medication, while knowing that it is causing harm by taking it, and wanting to stop but having difficulty doing so, or being unable to constitutes addiction. The many people that met this definition that I have discussed this with almost universally agreed that they are addicted to this medication and don't want to be. Many question whether living addicted to it is worthwhile, and a sevenfold higher rate of suicide suggests that to many it is not.
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