Endocrine Abstracts

A 37-year-old man of Romanian descent presented with complaints of back pain and was found to be HLA B27 positive. Subsequently, he was diagnosed as having Ankylosing spondylitis and he was initiated on high-dose steroids. The duration of regular steroid therapy lasted for more than ten years. After his move to the United Kingdom, he was referred to endocrinology outpatient clinic for symptoms of weight gain, muscle weakness, postural light-headedness, sexual dysfunction, fatigue, and skin striae. Examination revealed significant abdominal striae, a cushingoid appearance, and proximal muscle weakness, which is typical of Cushing’s syndrome. The biochemical tests showed hypogonadotropic hypogonadism, secondary hypothyroidism, and a positive short Synacthen test with an insulin stress test suggestive of inadequate cortisol and growth hormone response, A diagnosis of iatrogenic Cushing’s syndrome with secondary adrenal insufficiency was made. The patient was started on a tapering regimen of prednisolone to restore adrenal function, with doses reduced bi-weekly. Subsequently, he developed complications of Cushing’s syndrome, namely- osteoporosis, steroid-induced diabetes, hypercholesterolemia, and anemia for which he was treated. These were the significant side effects due to prolonged steroid use and the effect on the individual’s health and further requiring the use of medications to tackle the issues following the use. This case highlights the risks associated with long-term steroid therapy, the importance of appropriate tapering as well as close monitoring of steroid treatment to prevent complications and improve the patient’s quality of life.