Cushing's Syndrome From the Therapeutic Use of Intramuscular Dexamethasone Acetate

We present, to our knowledge, the first case of Cushing's syndrome due to large doses of intramuscular dexamethasone acetate. Dexamethasone levels after intramuscular dexamethasone administration were measured in two patients. Serial determination of the dexamethasone levels demonstrated prolonged serum half-lives of seven and 33 days in the two patients, respectively. Furthermore, pharmacologic levels of dexamethasone were present as long as seven months after the initial injections. The present recommendation for the use of intramuscular dexamethasone acetate is as frequent as every one to three weeks. However, our patients demonstrate that supraphysiologic levels of dexamethasone may still be present well beyond the three-week period.