Université Grenoble Alpes, Service d'Endocrinologie, CHU Grenoble Alpes, Unité Mixte de Recherche Inserm-CEA-UGA UMR1036, 38000 Grenoble, France.
Université Grenoble Alpes, Service d'Endocrinologie, CHU Grenoble Alpes, Unité Mixte de Recherche Inserm-CEA-UGA UMR1036, 38000 Grenoble, France.
Ann Endocrinol (Paris). 2023 May;84(3):370-372. doi: 10.1016/j.ando.2023.03.007. Epub 2023 Mar 22.
Prolonged exposition to supraphysiological doses of exogenous glucocorticoid eventually results in iatrogenic Cushing's syndrome, whose intensity depends on the dose and duration of the treatment and on individual susceptibility. In patients with chronic inflammatory diseases treated with oral glucocorticoids iatrogenic Cushing's is expected and recognized and it only imposes that the dose of glucocorticoid be maintained as low as possible and that there is no better alternative therapy available.In some cases, however, iatrogenic Cushing's syndrome may be unexpected by the prescribing physician as the true exposure to corticoids may depend largely on the patient: this is the case for topical steroids used in inflammatory skin diseases such as psoriasis. Factitious Cushing's syndrome (FCS) is another cause of exogenous Cushing's syndrome in whom the exposure to glucocorticoid is unexpected, as it is hidden to the physician by a patient suffering from Münchausen syndrome. FCS might be very difficult to diagnose depending on the type of glucocorticoid used, the specificity of the dosage used for cortisol, and the timing of the measurement of cortisol and ACTH. The best evidence for FCS is the demonstration by LC-MS/MS of exogenous glucocorticoid in his urine or plasma but this requires that the patient has not stopped to take glucocorticoid at the time of exploration. FCS related to hydrocortisone can be difficult to prove and to distinguish from cyclical Cushing's syndrome. Analysis of the literature shows that FCS has led to prolonged or invasive explorations and even to adrenal surgery, while unrecognized FCS has led to fatal infectious complications.
长期暴露于超生理剂量的外源性糖皮质激素最终会导致医源性库欣综合征，其严重程度取决于治疗的剂量和时间以及个体的易感性。在接受口服糖皮质激素治疗的慢性炎症性疾病患者中，预计会出现医源性库欣综合征，并且已经认识到这一点，这只需要将糖皮质激素的剂量保持在尽可能低的水平，并且没有更好的替代治疗方法可用。然而，在某些情况下，医源性库欣综合征可能是处方医生意料之外的，因为皮质激素的真正暴露可能在很大程度上取决于患者：这就是在炎症性皮肤病（如银屑病）中使用的局部类固醇的情况。人为库欣综合征（FCS）是另一种外源性库欣综合征的原因，在这种情况下，由于患者患有马方综合征，医生无法预料到糖皮质激素的暴露。根据使用的糖皮质激素类型、用于皮质醇的剂量的特异性以及皮质醇和 ACTH 的测量时间，FCS 的诊断可能非常困难。FCS 的最佳证据是通过 LC-MS/MS 在其尿液或血浆中检测到外源性糖皮质激素，但这需要患者在检查时尚未停止服用糖皮质激素。与氢化可的松相关的 FCS 很难证明，并且与周期性库欣综合征难以区分。对文献的分析表明，FCS 导致了延长或侵入性的探索，甚至导致肾上腺手术，而未被识别的 FCS 导致了致命的感染并发症。
