Deleterious effects of chronic use of corticosteroids: an approach to the development of Cushing's Syndrome




Deleterious effects; Glucocorticoide; Iatrogenic; Cushing's syndrome.


In recent decades there has been an undeniable advance in the development of new drugs, which have increased the patient's quality of life, as well as extended the life expectancy of the world population to which they have reach. However, it should be considered that exogenous substances, at supraphysiological levels, or even within normal levels, can mostly cause with deleterious effects, as is the case of corticosteroids, the focus of the study of this study. Articles from MEDLINE, PubMed, Elsevier, Nature Review were analyzed in order to explore the evolution of iatrogenic Cushing Syndrome (CS), which is related to the chronic use of Glucocorticoides (CG). For this purpose, biochemistry, mechanism of action, pharmacokinetics and metabolic effects of CG were described. The parallel with iatrogenic CS was traced in the description of the clinical diagnosis of the disease, based on the previous history of corticosteroid therapy of the patients, as well as the main techniques recommended for weaning the CG, which are with a lower degree of recurrence of the underlying disease and lower risk of adrenal insufficiency (dysfunctions of the Hypothalamus-Pituitary-Adrenal axis).


Amatruda, Jr. T. T., Hurst, M. M. & D’esopo, N. D. (1965) Certain endocrine and metabolic facets of the steroid withdrawal syndrome. J Clin Endocrinol Metab, 25, 1-207.

Amatruda, JR. T. T. et al. (1960) A study of the mechanism of the steroid with- drawal syndrome. Evidence for integrity of the hypothalamic- pituitary-adrenal system. J Clin Endocrinol Metab, 20, 339-54

Arnaldi, G. et al. (2003) Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab 88 (12), 5593-5602.

Berthelot, J.M., & Le Goff, B. & Maugars, Y. (2013) Side effects of corticosteroid injections: what's new? Joint Bone Spine. 80(4), 363-7. 10.1016/j.jbspin.2012.12.001. 10.1016/j.jbspin.2012.12.001

Bourdeau, I., El Ghorayeb, N., Gagnon, N. & Lacroix, A. (2018) Management of endocrine disease: Differential diagnosis, investigation and therapy of bilateral adrenal incidentalomas. Eur J Endocrinol. Aug,179(2):R57-R67. doi: 10.1530/EJE-18-0296. Epub 2018 May 10. PMID: 29748231 DOI: 10.1530/EJE-18-0296

Buchman, A. L. (2001) Side effects of corticosteroid therapy. J Clin Gastroenterol. 33(4):289-94. 10.1097/00004836-200110000-00006.

Dale, C. & Rang, M. M. (2012) Rang & Dale: farmacologia. (7a ed.), Elsevier.

Campagnolo, A. M. et al. (2008) Injeção de corticosteroide em patologias vocais inflamatórias crônicas, revisão da literatura. Rev. Bras. Otorrinolaringol., 74(6), 926-932, <>.

Chabre, O. (2014) Cushing syndrome: Physiopathology, etiology and principles of therapy. Presse Med. 43(4), 376-92. 10.1016/j.lpm.2014.02.001. 10.1016/j.lpm.2014.02.001.

Chaudhry, H. S. & Bhimji, S. S. (2018) Cushing Syndrome. In: StatPearls. Treasure Island (FL), StatPearls Publishing.

Dinsen S, Baslund B, Klose M, Rasmussen AK, Friis-Hansen L, Hilsted L & Feldt-Rasmussen U. (2013) Why glucocorticoid withdrawal may sometimes be as dangerous as the treatment itself. Eur J Intern Med. 24(8):714-20. 10.1016/j.ejim.2013.05.014. Eur J Intern Med. 25(8), 781-3.

Geer, E. (2017) The Hypothalamic-Pituitary-Adrenal Axis in Health and Disease. Springer.

Guignat, L., Bucy, C. & Bertherat, J. (2008) Glucocorticoid treatments and adrenal function. Rev Prat. 58(9):966-70.

Hall, J. E., & John E. (2017) Guyton & Hall Tratado de Fisiologia Médica GEN. (13a ed.). Guanabara Koogan.

Hochberg, Z., Pacak, K. & Chrousos, G. P. (2003) Endócrinas Withdrawal syndromes. Endocrine reviwes 24 (4), 523-538.

Hopkins, R. L & Leinung, M. C. (2005) Exogenous Cushing's syndrome and glucocorticoid withdrawal. Endocrinol Metab Clin North Am. 34(2), 371-84. 10.1016/j.ecl.2005.01.013.

Howlett, T. A., Rees, L. H. & Besser, G. M. (1985) Cushing's syndrome. Clin Endocrinol Metab. 14(4):911-45. 10.1016/s0300-595x(85)80083-9. 10.1016/s0300-595x(85)80083-9.

Kasper, D. L. et al. (2017) Harrison Medicina Interna, 2. (19a ed.), AMGH.

Kumar, V., Abbas, A. K. & Aster, J. C. (2013) Robbins patologia básica. (9a ed.), Elsevier.

Morgan, S. A, Hassan-Smith, Z. K & Lavery, G. G. (2020) Mechanisms in endocrinology: Tissue-specific activation of cortisol in Cushing’s syndrome. European Journal of Endocrinology. Volume/Issue: Volume 175: Issue 2. R81–R87.

Nelson, D. L. & Cox, Michael M. (2018) Princípios de Bioquímica de Lehninger. (7a ed.), Artmed.

Pereira A.S. et al. (2018). Metodologia da pesquisa científica. UFSM.

Romanholi, D. J. P. C. & Salgado, L. R. (2007) Síndrome de Cushing exógena e retirada de glicocorticoides. Arq Bras Endocrinol Metab, 51(8), 1280-1292, <>.

Runge, M. & Greganti, M. A. (2009) Netter Medicina Interna. (2a ed.), Elsevier.

Sahdev, A. et al. (2007) Imaging in Cushing’s Syndrome. <>.

Síndrome da retirada:

Swearigen, B. & Biller, B. (2011) Cushing’s Disease. Springer.

Vidyadhar, R. S., Suyog, S. D. & Shibhani, S. H. (2019) A Case of Iatrogenic Cushing Syndrome Secondary to Application of Topical Corticosteroids. Indian Dermatol Online J. 10(4):476-478. 10.4103/idoj.IDOJ_374_18. 10.4103/idoj.IDOJ_374_18

Waeber, P. V. G. (2012) Planifier un sevrage aux glucocorticoïdes: Stratégie diagnostique et thérapeutique. Praxis (2003), 92, 1675-1682.

Young Jr., W. (2011) The Netter Collection of Medical Illustrations, Volume 2: Endocrine System. (2a ed.), Elsevier.



How to Cite

TAVARES, F. R. S. .; LUZ , E. R. da .; SILVA, C. E. G. da .; CARVALHO , J. M. . L. de B. .; SOUSA, A. P. de .; FERREIRA, M. D. L. . Deleterious effects of chronic use of corticosteroids: an approach to the development of Cushing’s Syndrome. Research, Society and Development, [S. l.], v. 10, n. 4, p. e12310413487, 2021. DOI: 10.33448/rsd-v10i4.13487. Disponível em: Acesso em: 11 apr. 2021.



Health Sciences