Iatrogenic Cushing's Syndrome in a Patient With Salt-Wasting Congenital Adrenal Hyperplasia

A 17-year-old female with salt-wasting congenital adrenal hyperplasia (SWCAH) presented with symptoms indicative of iatrogenic Cushing's syndrome due to high doses of glucocorticoid therapy. Initial treatment included prednisone and fludrocortisone, which led to weight gain, hair loss, and other Cushing's symptoms. Adjustments were made by decreasing prednisone and increasing fludrocortisone, resulting in significant clinical improvements, including reduced headaches and salt cravings. After 7 months, laboratory values showed improved sodium levels and hormonal balance, with stable blood pressure and minimal weight gain. This case highlighted the importance of carefully balancing glucocorticoid and mineralocorticoid therapy in managing SWCAH.