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Iatrogenic Cushing's from Chronic Steroids — SCE Palliative Medicine MCQ

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EasyPain ManagementIatrogenic Cushing's from Chronic SteroidsSCE Palliative Medicine

A 70‑year‑old man with advanced cancer has been on long‑term corticosteroids. He develops proximal muscle weakness, weight gain, thin skin, easy bruising, and hyperglycaemia. What is the diagnosis?

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Correct answer: A — Iatrogenic Cushing’s syndrome – the effects of chronic exogenous corticosteroid excess

Option A is correct. The classic combination of proximal myopathy, cushingoid fat distribution with skin fragility and metabolic disturbance in the setting of long‑term steroids defines iatrogenic Cushing’s syndrome. B (myasthenia gravis) would present with fatigable ocular or bulbar weakness rather than skin changes or metabolic signs. C (Conn’s syndrome) causes hypertension and hypokalaemia but would not produce skin thinning, muscle weakness, or hyperglycaemia. D (cachexia) features weight loss and muscle wasting—not weight gain. E (Addison’s disease) reflects cortisol deficiency and would not cause hyperglycaemia or cushingoid appearance.

Reference: NHS, "Cushing’s syndrome", symptoms and causes (most common cause: long‑term steroids), accessed recently; BMJ Fardet et al., "Risk of cardiovascular events… iatrogenic Cushing’s syndrome", 2012, describing characteristic cushingoid features with chronic glucocorticoid use.