Iatrogenic Cushing’s syndrome post intralesional triamcinolone acetonide in Oral submucous fibrosis: 2 case reports

Abstract Background: Oral Submucous Fibrosis is a premalignant condition that is strongly linked to betel quid chewing. It exhibits a significantly higher rate of malignant transformation compared to other premalignant lesions. Fortunately, the use of Intralesional Triamcinolone Acetonide Injection has emerged as a highly effective treatment option and has become the cornerstone of managing this condition. Case Presentation: A 44-year-old female and a 40-year-old male presented with burning sensation and limited mouth opening, leading to a diagnosis of Oral Submucous Fibrosis. Both patients underwent treatment with Triamcinolone Acetonide Intralesional injections. Following a few months of treatment, a significant improvement in mouth opening was observed. However, both patients began experiencing symptoms such as facial rounding (mooning of the face), a buffalo hump, uneven hair growth, and swelling in the lower extremities. Upon recognizing these symptoms as indicative of Cushing's Syndrome, the administration of Triamcinolone Acetonide injections was discontinued. Both patients were referred to a higher-level medical facility for confirmatory tests, which revealed elevated cortisol levels in both morning (Cortisol A.M) and evening (Cortisol P.M). Conclusion: Triamcinolone Acetonide has been reported as an effective treatment for OSF. However, it is crucial to closely monitor patients for any adverse effects resulting from the treatment, which may arise from high dosage or increased frequency.