The client has developed iatrogenic Cushing's disease. Which statement explains the development?

• A. The client has an autoimmune problem causing the destruction of the adrenal cortex.
• B. The client has been taking steroid medications for an extended period for another disease process.
• C. The client has a pituitary gland tumor causing the adrenal glands to produce too much cortisol.
• D. The client has developed an adrenal gland problem for which the health-care provider does not have an explanation.

Answer: (B)

Prolonged use of corticosteroid medications is what drives iatrogenic Cushing's disease. When someone takes steroids for an extended period, the body’s own ACTH production is suppressed and the adrenal glands shrink (atrophy). The high level of cortisol effects you see come from the exogenous steroids, leading to the characteristic Cushingoid features like weight gain with central and facial fat, moon face, skin changes, hypertension, hyperglycemia, and osteoporosis. Because the cause is external steroid therapy rather than an internal tumor or autoimmune destruction, this is the explanation that best fits iatrogenic Cushing's.

Destruction of the adrenal cortex by an autoimmune process would cause Addison's disease (low cortisol), not Cushing's. A pituitary tumor causing excess ACTH would produce endogenous Cushing's disease, not iatrogenic. An adrenal problem with no explanation doesn’t identify the external steroid exposure that defines iatrogenic Cushing's.