CUSHING-SYNDROME DUE TO SURREPTITIOUS GLUCOCORTICOID ADMINISTRATION

We report a case of subtle Gushing syndrome in a Pakistani man who sel f-treated his asthma with a potent long-acting oral glucocorticoid (be tamethasone disodium phosphate [Bentelan]) for more than 30 years, He presented with cushingoid features, insulin resistance, and refractory hypertension Laboratory evaluation revealed undetectable cortisol lev els and suppression oi the hypothalamic-pituitary-adrenal axis. The pa tient obtained rho drug from his country of origin, with no understand ing of the potential adverse effects imposed by long-term use oi stero ids. He is now being slowly weaned off the drug, The apparent widespre ad availability, access, and abuse of such potent steroids are a cause of concern in developing countries, We suggest that physicians in the United States be aware of the potential abuse elf such potent drugs i n all populations, including immigrants.