Cushing's Syndrome Induced by Prolonged Dexamethasone Therapy: A Clinical Case Report

Background: Iatrogenic Cushing’s syndrome is a disorder characterized by chronic exposure to high levels of exogenous corticosteroids, most commonly dexamethasone. While corticosteroids are widely prescribed for their anti-inflammatory and immunosuppressive effects, their inappropriate or prolonged use—particularly in settings where medications are accessible without proper medical oversight—can lead to severe endocrine and systemic complications. These include characteristic physical changes such as moon face, central obesity, skin thinning, and muscle weakness, along with more serious consequences like metabolic derangements, opportunistic infections, osteoporosis, and adrenal suppression. In India and other developing countries, steroid misuse is prevalent due to over-the-counter availability and prescriptions by non-specialist practitioners, making iatrogenic Cushing’s syndrome an important yet preventable public health concern. Case Presentation: We report a case of a 49-year-old female admitted with vomiting, abdominal pain, and diarrhea for two days. Further evaluation revealed classical features of Cushing’s syndrome, including moon face, central obesity, and pedal edema. Laboratory and imaging studies indicated enter colitis, sepsis, acute kidney injury, and elevated serum cortisol levels. The patient had been taking dexamethasone 0.5 mg daily and diclofenac sodium 50 mg twice daily for over three years, prescribed by a local RMP. She was treated with IV fluids, antibiotics, supportive medications, and electrolyte replacement. Conclusion: This case highlights the critical role of clinical pharmacists in identifying and preventing steroid misuse, educating patients and healthcare providers, ensuring rational drug therapy, and assisting in the safe tapering and monitoring of corticosteroid use. Their involvement is vital in reducing the burden of preventable drug-induced conditions, especially in resource-limited settings.