[Unprecedented rise in Cushing's syndrome in addicts in Tehran]

Despite the widespread medical use of glucocorticoids, reports of factitious administration of these hormones have been uncommon. We herein report an unprecedented rise in outbreak of Cushing's syndrome in Tehran among addicts using Tamgesic [a brand of Buprenorphine] to help them through the narcotic withdrawal stage, without knowledge of the glucocorticoid content of the black-market drug. Case histories of 19 patients with a final diagnosis of iatrogenic Cushing syndrome were reviewed. Liquid chromatography/mass spectrometry [LC-Mass] method was used to evaluate glucocorticoid existence in the brand. No Buprenorphine was present in the vials. Each Tamgesic vial contained 0.4 mg of Dexamethasone disodium phosphate and some amount of heroin. The duration of injection abuse and the number of vials used per day was 4.5 [1-18] months and 6.5 [2-20], respectively. Physical findings of the cases were not different from those of the classic endogenous Cushing's syndrome but their serum cortisol and urinary free cortisol were suppressed. Severe life-threatening complications were demonstrated in five cases. Surreptitious use of steroids resulting in Cushing's syndrome may be more common in opium addicts; a high degree of suspicion is needed to uncover this disorder. Whenever facing a Cushingoid appearance in addicts, the possibility of using black market drugs with corticosteroid contents should be kept in mind

Hepatitis C virus antibodies and vitiligo disease

Vitiligo is a common skin disorder, characterized by depigmented patches due to selective destruction of melanocytes. The etiology of this disease is unknown. A number of hypotheses including viral theory have been proposed to explain the etiology. To determine the prevalence of antibody to hepatitis C virus infection in vitiligo patients, the present study was performed. Third generation ELISA test was used for detection of antibodies to HCV in human sera. All normal controls were anti-HCV negative whereas only one patient was positive for anti-HCV and there was no significant difference in the prevalence of anti-HCV between patients and controls. These results indicate that hepatitis C virus has not a direct causal role in the pathogenesis of vitiligo, however, this does not rul out a "hit and run" virus induced disease