Exogenous Cushing syndrome

Toggle: English / Spanish


Exogenous Cushing syndrome is a form of Cushing syndrome that occurs in people taking glucocorticoid (also called corticosteroid) hormones.

Alternative Names

Cushing syndrome - corticosteroid induced; Corticosteroid-induced Cushing syndrome; Iatrogenic Cushing syndrome


is a disorder that occurs when your body has a higher than normal level of the hormone cortisol. This hormone is normally made in the .

Exogenous means caused by something outside the body. Exogenous Cushing syndrome occurs when a person takes man-made (synthetic) glucocorticoid medicines to treat a disease.

Glucocorticoids are given for many diseases, such as lung diseases, skin conditions, inflammatory bowel disease, cancer, brain tumors, and joint disease. These medicines come in many forms, including pill, intravenous (IV), injection, enema, skin creams, inhalers, and eye drops.


Most people with Cushing syndrome have:

  • Round, red, full face (moon face)
  • Slow growth rate (in children)
  • Weight gain with fat accumulation on the trunk, but fat loss from the arms, legs, and buttocks (central obesity)

Skin changes that are often seen include:

  • Skin infections
  • Purple marks (1/2 inch or more wide), called striae, on the skin of the abdomen, thighs, and breasts
  • Thin skin with easy bruising

Muscle and bone changes include:

  • Backache, which occurs with routine activities
  • Bone pain or tenderness
  • Collection of fat between the shoulders and above the collar bone
  • Rib and spine fractures caused by thinning of the bones
  • Weak muscles, especially of the hips and shoulders

Women may have:

  • Excess hair growth on the face, neck, chest, abdomen, and thighs
  • Periods that become irregular or stop

Men may have:

Other symptoms that may occur include:

  • Mental changes, such as depression, anxiety, or changes in behavior
  • Fatigue
  • Headache
  • Increased thirst and urination

Exams and Tests

The health care provider will perform a physical exam and ask about your symptoms and the medicines you are taking. Tell the provider about all medicines you have been taking for the past several months. Also tell the provider about shots that you received at a provider's office.

If you use cortisone, prednisone, or other corticosteroids, the following test results may suggest exogenous Cushing syndrome:

A method called high performance liquid chromatography (HPLC) can show a high level of the suspected medicine in the urine.


Treatment is to slowly decrease and eventually stop taking any corticosteroids. Do not stop taking any medicine without first talking to your provider. Suddenly stopping corticosteroids after taking them for a long time can result in a life-threatening condition called adrenal crisis.

If you cannot stop taking the medicine because of disease (for example, you need steroids to treat severe asthma), follow your provider's instructions on how to reduce the possibility of developing complications, including:

  • Treating high blood sugar with diet, oral medicines, or insulin.
  • Treating high cholesterol with diet or medicines.
  • Taking medicines to prevent bone loss. This can help reduce the risk of fractures if you develop osteoporosis.
  • Taking medicine to decrease the amount of glucocorticoid medicine that you need.

Outlook (Prognosis)

Slowly tapering the medicine that is causing the condition can help reverse the effects of adrenal gland shrinkage (atrophy). This may take as long as a year. During this time, you may need to restart or increase the dosage of your steroids in times of stress or illness.

Possible Complications

Health problems that may result from exogenous Cushing syndrome include any of the following:

  • Low immune system, which may lead to frequent infections
  • Damage to the eyes, kidneys, and nerves due to untreated high blood sugar
  • Diabetes
  • High cholesterol levels
  • Increased risk of heart attack from untreated diabetes and high cholesterol
  • Weak bones (osteoporosis) and increased risk of fractures

These complications can generally be prevented with proper treatment.

When to Contact a Medical Professional

Call for an appointment with your provider if you are taking a corticosteroid and you develop symptoms of Cushing syndrome.


If you take a corticosteroid, know the signs and symptoms of Cushing syndrome. Getting treated early can help prevent any long-term effects of Cushing syndrome. If you use inhaled steroids, you can decrease your exposure to the steroids by using a spacer and by rinsing your mouth after breathing in the steroids.


Ferri FF. Cushing's disease and syndrome. In: Ferri FF, ed. Ferri's Clinical Advisor 2016. Philadelphia: PA Elsevier Mosby; 2016:385-386.

Nieman LK, Biller BM, Findling JW, et al. Treatment of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015;100:2807-2831. PMID: 26222757 www.ncbi.nlm.nih.gov/pubmed/26222757.

Stewart PM, Newell-Price JDC. The adrenal cortex. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 15.

Version Info

  • Last reviewed on 10/28/2015
  • Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch)

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2013 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.