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Dexamethasone is a fluorinated glucocorticoid medication [10] used to treat rheumatic problems, a number of skin diseases, severe allergies, asthma, chronic obstructive pulmonary disease (COPD), croup, brain swelling, eye pain following eye surgery, superior vena cava syndrome (a complication of some forms of cancer), [11] and along with antibiotics in tuberculosis. [10]
Two dexamethasone suppression tests (DSTs) are generally used, the overnight test and the 48 hour test. [8] For both tests, a plasma cortisol level above 50 nmol/L is indicative of Cushing's disease. [8] However, 3–8% of patients with Cushing's disease will test negative due to a retention of dexamethasone suppression abilities. [8]
Dexamethasone is an exogenous steroid that provides negative feedback to the pituitary gland to suppress the secretion of adrenocorticotropic hormone (ACTH). Specifically, dexamethasone binds to glucocorticoid receptors in the anterior pituitary gland, which lie outside the blood–brain barrier , resulting in regulatory modulation.
A 2007 Swedish clinical trial found that treatment may cause cognitive and behavioural defects, but the small number of test subjects means the study cannot be considered definitive. A 2012 American study found no negative short-term outcomes, but "lower cognitive processing in CAH girls and women with long-term dexamethasone exposure."
Cushing's syndrome is a collection of signs and symptoms due to prolonged exposure to glucocorticoids such as cortisol. [4] [9] [10] Signs and symptoms may include high blood pressure, abdominal obesity but with thin arms and legs, reddish stretch marks, a round red face due to facial plethora, [11] a fat lump between the shoulders, weak muscles, weak bones, acne, and fragile skin that heals ...
The patient had a fraternal twin brother, and the two previously performed in parallel academically, but following the steroid treatment the patient exhibited poor memory, attention, concentration, insomnia, and avoidance of eye contact. As a result, he began to fall behind his twin brother in academic, developmental, and social areas.