Are there any differences in symptoms of iatrogenic and endogenous Cushing’s features?

There are few clinical features which are more common and some features which are less common in iatrogenic Cushing’s. Hypertension though common in iatrogenic Cushing’s, these patients may have relatively less hypertension and hypokalemia compared with patients who have spontaneous Cushing’s syndrome depending on the mineralocorticoid activity of the steroid they are taking. Patients with iatrogenic Cushing’s syndrome are less likely to have significant increases in androgens, and therefore they have less hirsutism and other virilizing features than those who have spontaneous disease. There is increased incidence of glaucoma and other ocular disease such as posterior subcapsular cataracts in these patients. Avascular necrosis is more common in iatrogenic than in spontaneous Cushing’s syndrome. Osteoporosis is a common and severe adverse effect of glucocorticoid excess and one of the major limitations to long-term glucocorticoid therapy. A signifi-cant number of patients on long-term steroid therapy will have at least some loss of bone density. Oral and inhaled corticosteroid uses are associated with increased bone fractures. The bone loss caused by glucocorticoids tends to be in trabecular bone as opposed to cortical bone. Therefore, most loss is in the vertebrae and ribs of the axial skeleton.

• Hypertension, hypokalemia, androgenic features like hirsutism and oligoamenorrhea are less common in iatrogenic Cushing’s syndrome.

• Certain features such as posterior subcapsular cataract, glaucoma, avascular necrosis of femur osteoporosis and pancreatitis are more common in iatrogenic Cushing’s syndrome than endogenous Cushing’s syndrome.