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

anaphylaxis

angioedema

 

Cardiovascular System

 

bradycardia

cardiac arrestii

cardiac arrhythmias

cardiac enlargement 

circulatory collapse

congestive heart failure

ECG changes caused by potassium deficiency 

edema

fat embolism

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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