Glucocorticoid misuse in a rural and semi-urban community of North Bihar: a pilot study

Glucocorticoid misuse is a common problem in northern Bihar. There is very little published literature regarding the magnitude of glucocorticoid misuse in South Asia. All inpatients and medical outpatients presenting to Duncan Hospital with suspected glucocorticoid abuse were screened over a six-month period. Patients presenting with iatrogenic Cushing's syndrome and hypoadrenal crisis were assessed clinically and biochemically for the side effects of glucocorticoid misuse. Twenty-two patients were seen in the hospital over a period of six months. Fifteen patients presented with iatrogenic Cushing's syndrome (68.2%) and seven with hypoadrenal crisis (31.8%). Ten were found to have cataracts, six had a recent onset of diabetes, five had a recent onset of hypertension and 12 had osteoporotic fractures of the spine. Glucocorticoid misuse is an important problem which has been inadequately addressed in the rural and semi-urban communities of northern Bihar.