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Iatrogenic Cushing's syndrome — SCE Endocrinology MCQ

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HardAdrenalIatrogenic Cushing's syndromeSCE Endocrinology

A 45-year-old woman with asthma uses high-dose inhaled fluticasone and ritonavir. She develops central weight gain, bruising and proximal weakness. Morning cortisol is suppressed. What is the most likely diagnosis?

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Correct answer: C — Iatrogenic Cushing's syndrome with adrenal suppression

Ritonavir inhibits steroid metabolism and can cause systemic glucocorticoid excess from inhaled fluticasone, with secondary adrenal suppression. Cushing's disease would have endogenous ACTH-driven cortisol excess rather than suppressed cortisol from exogenous exposure. Drug history is critical in apparent Cushing's syndrome.

Reference: BNF; Society for Endocrinology Steroid Guidance