What condition is indicated by unintentional weight gain and purple stretch marks (striae) on the abdomen in a patient using corticosteroids (cortico-steroids)?

From the Guidelines

Unintentional weight gain and purple stretch marks (striae) on the abdomen in a patient using corticosteroids likely indicates Cushing's syndrome, specifically iatrogenic Cushing's syndrome. This condition occurs when exogenous corticosteroid medications like prednisone, dexamethasone, or hydrocortisone cause an excess of cortisol in the body, as discussed in the study by 1. The characteristic purple striae develop because cortisol weakens collagen fibers in the skin, making it more susceptible to stretching and tearing as weight increases, particularly in the abdominal area. Some key points to consider in this condition include:

• Other symptoms may include a rounded "moon face," buffalo hump (fat accumulation between the shoulders), thin skin, easy bruising, muscle weakness, and mood changes.
• Management typically involves gradually tapering the corticosteroid dose under medical supervision rather than stopping abruptly, which could trigger adrenal crisis, as noted in the study by 1.
• Alternative treatments for the original condition being treated should be considered, taking into account the potential for weight gain and other side effects associated with corticosteroid use, as discussed in the study by 1.
• Regular monitoring of blood pressure, blood glucose, and bone density is important for patients on long-term corticosteroid therapy to prevent or manage these complications. It's essential to weigh the benefits and risks of corticosteroid therapy, considering the potential for significant weight gain and other adverse effects, as highlighted in the study by 1, which suggests that the impact of glucocorticoids on body composition can be profound, resulting in central deposition of adipose tissue and a marked catabolic effect on bone and muscle.

From the Research

Condition Indicated by Unintentional Weight Gain and Purple Stretch Marks

The condition indicated by unintentional weight gain and purple stretch marks (striae) on the abdomen in a patient using corticosteroids is likely Cushing syndrome.

• Cushing syndrome is defined as a prolonged increase in plasma cortisol levels that is not due to a physiological etiology 2.
• The syndrome is associated with hyperglycemia, protein catabolism, immunosuppression, hypertension, weight gain, neurocognitive changes, and mood disorders 2.
• Characteristic skin changes include facial plethora, easy bruising, and purple striae, along with metabolic manifestations such as hyperglycemia, hypertension, and excess fat deposition in the face, back of the neck, and visceral organs 2, 3.
• The clinical presentation of Cushing syndrome can be variable, and diagnosis may not be considered until many features have accumulated 3, 4.
• Screening for Cushing syndrome typically involves tests such as 24-hour urinary free cortisol, bedtime salivary cortisol, and/or 1 mg dexamethasone suppression test 3, 4, 5.

Diagnostic Considerations

• Initial workup should start with excluding local and systemic corticosteroid use 4.
• First-line screening tests, including the 1-mg dexamethasone suppression test, 24-hour urinary free cortisol excretion, and late-night salivary cortisol measurement, should be performed to screen for endogenous Cushing syndrome 4, 5.
• Measurement of plasma ACTH concentrations can help differentiate between ACTH-dependent and ACTH-independent causes of Cushing syndrome 2, 3, 4.

Management and Prognosis

• Management of Cushing syndrome typically involves surgery to remove the source of excess endogenous cortisol production, followed by medication and possibly radiation therapy or bilateral adrenalectomy 2, 3.
• Survival probabilities in patients with ectopic Cushing's syndrome vary depending on the underlying origin of the tumor, tumor stage, and severity of hypercortisolism 6.