Exogenous Cushing’s Syndrome with Secondary Adrenal Insufficiency in an Asthmatic Infant: “Healing Evil with Evil”

Abstract

Exogenous Cushing’s syndrome is an ACTH-independent endocrine disorder, characterized by specific signs resulting from excessive glucocorticoid intake. This is mainly the case in the course of management of corticotherapy-necessitating chronic diseases such as asthma. It may occasionally lead to secondary Adrenal insufficiency, which is the inability of the adrenal glands to produce hormones, precisely cortisol and aldosterone, due to lack of secretion of ACTH from a suppressed pituitary gland. The clinical presentation of adrenal insufficiency may be gradual and nonspecific, depending on the degree of insufficiency and precipitating stress event. Symptoms may include fatigue, nausea, muscle weakness, and headache. We here present the case of an asthmatic infant treated with glucocorticoids, who came presenting with some of the above symptoms after the interruption of his medication, with onset of exogenous Cushing’s syndrome. The particularity of this case report is the association of iatrogenic Cushing’s syndrome with secondary adrenal insufficiency in an asthmatic infant. This is rare and very less reported in the pediatric population. Yet, it was effectively managed with a salt restriction diet and the re-administration of hydrocortisone, which is a glucocorticoid too. As such, a disorder caused by the intake of glucocorticoid had definitely found its solution in a treatment with glucocorticoids. Somehow-“healing evil with evil” or a “hair of the dog that bit you”.