Authors: Azizi, Fereidoun¹; Jahed, Adel²; Hedayati, Mehdi¹; Lankarani, Mahnaz³; Bejestani, Hadi Shahrad⁴; Esfahanian, Fatemeh⁵; Beyraghi, Nargues⁶; Noroozi, Alireza⁷; Kobarfard, Farzad⁸

Source: Clinical Endocrinology, Volume 69, Number 6, December 2008 , pp. 921-925(5)

Publisher: Wiley-Blackwell

Abstract:

Summary 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.

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1365-2265.2008.03290.x

Affiliations: 1: Research Institute for Endocrine Sciences, Shahid Beheshti University (M.C.), Tehran, Iran, 2: Department of Endocrinology and Internal Medicine, Boo-ali University Hospital, Islamic Azad University, Tehran Medical Branch, Tehran, Iran, 3: Endocrinology and Metabolism Research Center, Dr. Shariati University Hospital, Tehran University (M.C.), Tehran, Iran, 4: Department of Endocrinology and Internal Medicine, Rasool-e-Akram University Hospital, Iran University of Medical Sciences, Tehran, Iran, 5: Department of Endocrinology, Imam Khomeini University Hospital, Tehran University (M.C.), Tehran, Iran, 6: Postgraduate Dean Office and Psychiatry Ward, Taleghani University Hospital, Shahid Beheshti University (M.C.), Tehran, Iran, 7: Substance Abuse Prevention and Treatment Office (SAPTO), Deputy for Health, Ministry of Health and Medical Education, Tehran, Iran, 8: Department of Medical Chemistry, School of Pharmacy, Shahid Beheshti University (M.C.), Tehran, Iran

Publication date: 2008-12-01

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• In this Subject: Anatomy & Physiology ,  Internal Medicine
• By this author: Azizi, Fereidoun ;  Jahed, Adel ;  Hedayati, Mehdi ;  Lankarani, Mahnaz ;  Bejestani, Hadi Shahrad ;  Esfahanian, Fatemeh ;  Beyraghi, Nargues ;  Noroozi, Alireza ;  Kobarfard, Farzad

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