How do chronic exogenous glucocorticoids lead to Cushingoid features?

How do chronic exogenous glucocorticoids lead to Cushingoid features?

• A. They increase ACTH production.
• B. They cause hypercortisolism with negative feedback on ACTH, producing symptoms similar to endogenous Cushing's.
• C. They stimulate endogenous cortisol production.
• D. They decrease cortisol levels leading to fatigue.

Answer: (B)

Chronic exogenous glucocorticoids cause systemic glucocorticoid excess. When these steroids are taken over time, they provide cortisol-like activity in the body, which triggers negative feedback at the hypothalamus and pituitary. This lowers CRH and ACTH production, so endogenous cortisol production falls. Despite the suppressed ACTH, the external glucocorticoids continue to drive high glucocorticoid effects, leading to the Cushingoid features such as weight redistribution, facial rounding, proximal muscle weakness, thinning skin, glucose intolerance, and hypertension. In other words, the symptoms come from excess glucocorticoid action with low ACTH, not from increased ACTH or from low cortisol.

Chronic exogenous glucocorticoids cause systemic glucocorticoid excess. When these steroids are taken over time, they provide cortisol-like activity in the body, which triggers negative feedback at the hypothalamus and pituitary. This lowers CRH and ACTH production, so endogenous cortisol production falls. Despite the suppressed ACTH, the external glucocorticoids continue to drive high glucocorticoid effects, leading to the Cushingoid features such as weight redistribution, facial rounding, proximal muscle weakness, thinning skin, glucose intolerance, and hypertension. In other words, the symptoms come from excess glucocorticoid action with low ACTH, not from increased ACTH or from low cortisol.