Local Injection of Triamcinolone Acetonide: A Forgotten Etiology of Cushing’s Syndrome

In 2017, a case series was reported on iatrogenic Cushing’s Syndrome (CS) resulting from non-systemic corticosteroid administrations for keloid scars treatment and an aesthetic regimen called mesotherapy. The first patient developed CS after exceeding the recommended dose of intralesional injection of Triamcinolone Acetonide (TAC). The second case presented with CS following unidentified mesotherapy treatment for local fat reduction, which included subcutaneous injections of dexamethasone. The study concluded that physicians should be cautious in prescribing TAC, especially to patients with high predisposing factors for developing CS. Similarly, off-label mesotherapy combined with corticosteroid can lead to iatrogenic CS and Hypothalamic-Pituitary-Adrenal (HPA) axis suppression. At the time, there were no standard guidelines for mesotherapy treatment, and further clinical trials were recommended to increase safety.