Cushing’s syndrome and adrenal insufficiency after intradermal triamcinolone acetonide for keloid scars

Finken, Martijn J J; Mul, Dick

doi:10.1007/s00431-010-1165-z

Cited by 29 publications

(18 citation statements)

References 6 publications

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“…Similarly, in our study, half the patients who used exogenous steroids were documented as having AI. Cushingoid appearance in individuals with AI who also use corticosteroids has been described in multiple case reports of topical steroid therapy [23,24]. High-dose or chronic glucocorticoid use from prescribed or surreptitious use can result in Cushingoid appearance.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors of Adrenal Insufficiency in Outpatients with Indeterminate Serum Cortisol Levels: A Retrospective Study

et al. 2020

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Background and Objectives: To diagnose adrenal insufficiency (AI), adrenocorticotropic hormone (ACTH) stimulation tests may need to be performed, but those tests may not be available in some institutions. In addition, they may not be necessary for some patients. The objective of this study was to identify clinical and biochemical factors that could facilitate AI diagnosis in outpatient departments and decrease the number of unnecessary dynamic tests. Materials and Methods: This seven-year retrospective study was performed in a tertiary care medical center. A total of 517 patients who had undergone ACTH stimulation tests in the outpatient department were identified. AI was described as a peak serum cortisol level of <18 µg/dL at 30 or 60 min after stimulation. The associations between clinical factors, biochemical factors, and AI were analyzed using the Poisson regression model and reported by the risk ratio (RR). Results: AI was identified in 128 patients (24.7%). Significant predictive factors for the diagnosis of AI were chronic kidney disease (RR = 2.52, p < 0.001), Cushingoid appearance (RR = 3.44, p < 0.001), nausea and/or vomiting (RR = 1.84, p = 0.003), fatigue (RR = 1.23, p < 0.001), serum basal cortisol <9 µg/dL (RR = 3.36, p < 0.001), serum cholesterol <150 mg/dL (RR = 1.26, p < 0.001), and serum sodium <135 mEq/L (RR = 1.09, p = 0.001). The predictive ability of the model was 83% based on the area under the curve. Conclusion: The easy-to-obtain clinical and biochemical factors identified may facilitate AI diagnosis and help identify patients with suspected AI. Using these factors in clinical practice may also reduce the number of nonessential dynamic tests for AI.

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Section: Discussionmentioning

confidence: 99%

Predictive Factors of Adrenal Insufficiency in Outpatients with Indeterminate Serum Cortisol Levels: A Retrospective Study

et al. 2020

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“…Triamcinolone can be administered by an intraarticular, intralesional, topical, or intramuscular route. Triamcinolone is intermediate-acting and is 5 times more potent than cortisol, so injections, such as the one given to our patient, can have harmful side effects (6). The biological half-life of triamcinolone is 18 to 36 hours, but the preparation can contribute to wide variations (7).…”

Section: Discussionmentioning

confidence: 99%

Depot Triamcinolone Injection Contributing to Adrenal Suppression and Cushing Syndrome: Case Report and Literature Review

Modarelli

Stephen

2019

AACE Clinical Case Reports

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Objective:To present an unusual case of Cushing syndrome in a pediatric patient caused by a single depot triamcinolone injection.Methods: A case report followed by a literature review are presented.Results: A 13-year-old male presented with rapid weight gain, elevated blood pressure, headaches, and diffuse purplish striae. Lab results revealed a low 24-hour urinary free cortisol of <3 µg (reference range is 4.0 to 56 µg/24 hours), a low midnight salivary cortisol of <50 ng/dL (reference range is <100 ng/dL), a low adrenocorticotropic hormone of <5 pg/mL (reference range is 6 to 55 pg/mL), and a lower than expected testosterone of 86 ng/dL. The values were not consistent, and upon further questioning the family admitted the patient had received a "Jesus shot" from a practitioner which was sold as a cure all. Upon further investigation, it was determined that this injection contained both dexamethasone and depot triamcinolone. The triamcinolone in this injection was quantified and remained measureable for over 4 months following injection. Conclusion:The cause of Cushing syndrome symptoms with adrenal suppression was exogenous glucocorticoid, specifically depot triamcinolone. Exogenous glucocorticoids can create adrenal suppression, contributing to life-threatening adrenal crises with illness or stress. Recovery of our patient's adrenal axis was demonstrable within a few months. This case highlights the potentially devastating effects of glucocorticoid treatment for unclear medical indications. Further, it raises concerns about the potential unintended consequences of such therapies and the importance for providers to raise additional questions whenever the clinical presentation and laboratory investigation are inconsistent. (AACE Clinical Case Rep. 2019;5:e1-e3) Abbreviations: CS = Cushing syndrome; HPA = hypothalamic-pituitary-adrenal

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“…In rare occasions Cushing’s syndrome is related to topical treatment of uveitis4 or intradermal treatment with triamcinolone acetonide 5…”

Section: Discussionmentioning

confidence: 99%

Exogenous Cushing's syndrome due to a Chinese herbalist’s prescription of ointment containing dexamethasone

Franke

Scholtens²,

Rosenstiel

et al. 2017

BMJ Case Reports

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Eczema in children is a chronic disabling condition. The impact of this condition on the lives of families is often underestimated by conventional physicians. As a consequence parents may investigate complementary treatment options. Close monitoring by a paediatrician is essential, considering that a variety of adverse effects can occur during the use of complementary treatment. We present a 5-year-old girl with eczema. She visited a Chinese herbalist who prescribed an ointment. The parents noticed that the eczema resolved fast, itching decreased and she was finally sleeping well. However, her behaviour changed and appetite increased. Undetectable levels of serum cortisol were found, which was indicative of exogenous Cushing's syndrome. Analysis of the ointment revealed the presence of dexamethasone. Hydrocortisone substitution and subsequently a reduction schedule were implemented, after which endogenous cortisol production recovered after 4 months. Physicians should be aware that unregistered herbal medicine can contain potent drugs such as glucocorticoids.

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Cushing’s syndrome and adrenal insufficiency after intradermal triamcinolone acetonide for keloid scars

Cited by 29 publications

References 6 publications

Predictive Factors of Adrenal Insufficiency in Outpatients with Indeterminate Serum Cortisol Levels: A Retrospective Study

Predictive Factors of Adrenal Insufficiency in Outpatients with Indeterminate Serum Cortisol Levels: A Retrospective Study

Depot Triamcinolone Injection Contributing to Adrenal Suppression and Cushing Syndrome: Case Report and Literature Review

Exogenous Cushing's syndrome due to a Chinese herbalist’s prescription of ointment containing dexamethasone

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