Outbreak of exogenous Cushing's syndrome due to unlicensed medications

Azizi, F. and Jahed, A. and Hedayati, M. and Lankarani, M. and Bejestani, H.S. and Esfahanian, F. and Beyraghi, N. and Noroozi, A. and Kobarfard, F. (2008) Outbreak of exogenous Cushing's syndrome due to unlicensed medications. Clinical Endocrinology, 69 (6). pp. 921-925.

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Objective: Despite the widespread medical use of glucocorticoids, reports of factitious administration of these hormones have been uncommon. We herein report an outbreak of Cushing's syndrome in Tehran among the addicts using Tamgesic (a brand of Buprenorphine) to help them through the narcotic withdrawal stage, without knowledge of the glucocorticoid content of the black-market drug. Design and measurements: Case histories of 19 patients with a final diagnosis of iatrogenic Cushing's syndrome were reviewed. Liquid chromatography/mass spectrometry (LC-Mass) method was used to evaluate glucocorticoid existence in the brand. High performance liquid chromatography was used to determine plasma dexamethasone level. Results: No buprenorphine was present in the vials. Each Tamgesic vial contained 0.4 mg of Dexamethasone disodium phosphate; Heroin was also found in them. The duration of injection abuse and the total dexamethasone intake was 4.5 (1-18) months and 2.6 (0.8-8) mg/day, respectively. Median plasma dexamethasone concentration was 5.8 nmol/l, with a range of 5-8.7. Physical findings of the cases were not different from those of the classic endogenous Cushing's syndrome but their serum cortisol and urinary free cortisol were suppressed. Severe life-threatening complications were demonstrated in five cases. Conclusion: Surreptitious use of steroids resulting in Cushing's syndrome may be more common in opium addicts; a high degree of suspicion is needed to uncover this disorder. Whenever facing a cushingoid appearance in addicts, the possibility of using black market drugs with corticosteroid contents should be kept in mind. © 2008 The Authors.

Item Type: Article
Additional Information: cited By 8
Uncontrolled Keywords: acetylcodeine; buprenorphine; dexamethasone; dexamethasone sodium phosphate; diamorphine; pheniramine; prednisolone; tamgesic; unclassified drug, adrenal cortex insufficiency; adult; article; clinical article; Cushing syndrome; drug blood level; drug dependence; drug dose reduction; drug traffic; epidemic; high performance liquid chromatography; human; hydrocortisone blood level; hydrocortisone urine level; iatrogenic disease; laboratory test; liquid chromatography; male; mass spectrometry; priority journal; withdrawal syndrome, Adult; Buprenorphine; Cushing Syndrome; Dexamethasone; Drug Contamination; Humans; Hydrocortisone; Iatrogenic Disease; Male; Middle Aged; Opioid-Related Disorders; Opium; Substance Withdrawal Syndrome
Subjects: WK Endocrine System
QV Pharmacology
Depositing User: Arezoo Ghasemi siani
Date Deposited: 13 Dec 2020 08:42
Last Modified: 13 Dec 2020 08:42
URI: http://eprints.iums.ac.ir/id/eprint/22644

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