Iatrogenic Cushing's Syndrome and Fatal Adrenal Crisis Following Systemic Corticosteroid Therapy: A Case Series of Five Patients.

Corticosteroids are indispensable in the management of inflammatory, autoimmune, and respiratory disease, yet prolonged or unsupervised systemic use can produce iatrogenic Cushing's syndrome, and abrupt withdrawal risks life-threatening adrenal crisis. We report five male patients, aged 12 to 65 years, who developed Cushingoid features following systemic corticosteroid exposure for type two diabetes-associated dermatosis, bronchial asthma, epileptic encephalopathy, rheumatoid arthritis, and osteoarthritis. All five presented with moon facies; additional findings included purple striae, cutaneous thinning, abdominal hyperpigmentation, and impaired wound healing. Where measured, serum cortisol was low or low-normal, consistent with hypothalamic-pituitary-adrenal (HPA) axis suppression by exogenous steroid and thereby confirming an iatrogenic rather than endogenous origin. Opportunistic fungal infection masked by corticosteroid-mediated immunosuppression was a recurring complication. In one patient, abrupt discontinuation of dexamethasone precipitated adrenal crisis, multi-organ failure, and death. The remaining four patients recovered fully following structured tapering or physiological corticosteroid replacement. This report illustrates the clinical spectrum of iatrogenic hypercortisolism, emphasises the diagnostic significance of a suppressed endogenous cortisol, and underscores the imperative of gradual steroid withdrawal. It highlights the essential role of clinical pharmacists in rational prescribing, early adverse-effect recognition, and safe steroid tapering within a multidisciplinary care framework.