{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T21:44:07Z","timestamp":1777585447020,"version":"3.51.4"},"reference-count":12,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Med Insights Endocrinol Diabetes"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>Iatrogenic Cushing syndrome can occur due to the use of external glucocorticoids. We present a case involving prolonged exposure to glucocorticoids from intramuscular dexamethasone injections, with diagnosis confirmed via abscess fluid analysis. This underscores the importance of considering altered pharmacokinetics when faced with unexplained hypercortisolism. A 46-year-old woman experienced hypertension, weakness, edema, and increasing abdominal striae over 6\u2009months. Her history included undocumented intramuscular injections for back pain a year earlier, which resulted in bilateral gluteal abscesses. Laboratory results showed suppressed morning cortisol and adrenocorticotrophic hormone levels, while imaging ruled out structural abnormalities. Although serum tests were negative, liquid chromatography\u2013mass spectrometry performed on abscess fluid detected dexamethasone (81.1\u2009nmol\/L), confirming iatrogenic Cushing syndrome. This case highlights how local tissue changes, such as abscesses, can significantly modify glucocorticoid pharmacokinetics, creating a prolonged reservoir effect and sustained systemic exposure lasting more than a year after injection. Overall, atypical pharmacokinetics are important in cases of unexplained hypercortisolism, especially when local tissue alterations influence drug absorption and clearance. Analyzing collections like abscess fluid can provide vital diagnostic clues in complex suspected cases of iatrogenic Cushing syndrome.<\/jats:p>","DOI":"10.1177\/11795514251376453","type":"journal-article","created":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T06:12:53Z","timestamp":1764655973000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Delayed Dexamethasone Absorption from Gluteal Abscesses: Persistent Iatrogenic Cushing Syndrome"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4665-3468","authenticated-orcid":false,"given":"Domas","family":"Grigoravicius","sequence":"first","affiliation":[{"name":"Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karolis","family":"Laucius","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rasa","family":"Ugenskiene","sequence":"additional","affiliation":[{"name":"Genetic and Molecular Medicine Clinic, The Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vaida","family":"Stankute","sequence":"additional","affiliation":[{"name":"Genetic and Molecular Medicine Clinic, The Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1510-8263","authenticated-orcid":false,"given":"Zydrune","family":"Visockiene","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,12]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgac492"},{"key":"e_1_3_4_3_2","unstructured":"Chaudhry HS Singh G. Cushing syndrome. In: StatPearls [Internet]. StatPearls Publishing; 2025. 2025 Feb 1]. Accessed February 1 2025. http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK470218\/"},{"key":"e_1_3_4_4_2","article-title":"Cushing syndrome following single steroid injection: a case report and review of the literature","volume":"4","author":"Motawea M","unstructured":"Motawea M, Mosaad H, Aladeeb NM, El-khalek AMA. Cushing syndrome following single steroid injection: a case report and review of the literature. Am J Med Case Rep. 2016;4(4):130-133.","journal-title":"Am J Med Case Rep"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0163-7258(02)00297-8"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1515\/jpem-2025-0032"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1986.00360210246041"},{"key":"e_1_3_4_8_2","unstructured":"State Medicines Control Agency. Dexamethasone sodium phosphate: Product characteristics [Internet]. 2021. Accessed January 27 2025. https:\/\/vapris.vvkt.lt\/vvkt-web\/public\/medications\/view\/28893"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.4158\/EP.15.3.225"},{"issue":"3","key":"e_1_3_4_10_2","first-page":"222","article-title":"The effect of corticosteroids on subcutaneous abcess formation in the mouse","volume":"62","author":"Joiner KA","year":"1981","unstructured":"Joiner KA, Gelfand JA, Bartlett JG, Gorbach SL. The effect of corticosteroids on subcutaneous abcess formation in the mouse. Int J Exp Pathol. 1981;62(3):222-226.","journal-title":"Int J Exp Pathol"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2019.00129"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ando.2023.03.007"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-12-0594"}],"container-title":["Clinical Medicine Insights: Endocrinology and Diabetes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11795514251376453","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/11795514251376453","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11795514251376453","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T20:00:17Z","timestamp":1777406417000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/11795514251376453"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":12,"alternative-id":["10.1177\/11795514251376453"],"URL":"https:\/\/doi.org\/10.1177\/11795514251376453","relation":{},"ISSN":["1179-5514","1179-5514"],"issn-type":[{"value":"1179-5514","type":"print"},{"value":"1179-5514","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]},"article-number":"11795514251376453"}}