Exogenous Cushing’s syndrome due to topical corticosteroid application: case report and review literature

Tempark, Therdpong; Phatarakijnirund, Voraluk; Chatproedprai, Susheera; Watcharasindhu, Suttipong; Supornsilchai, Vichit; Wananukul, Siriwan

doi:10.1007/s12020-010-9393-6

Cited by 105 publications

(102 citation statements)

References 39 publications

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“…In such patients, when medication is stopped or rapidly tapered, adrenal crisis may take place. Not only oral but also nasal [34], transdermal [35] or transbronchial [36] administration of GC can suppress the HPA axis. According to a report from the United Kingdom [36], 23 of 2,900 patients had a low blood sugar level after use of inhaled GC.…”

Section: I-43mentioning

confidence: 99%

Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]

et al. 2016

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Abstract. This clinical practice guideline of the diagnosis and treatment of adrenal insufficiency (AI) including adrenal crisis was produced on behalf of the Japan Endocrine Society. This evidence-based guideline was developed by a committee including all authors, and was reviewed by a subcommittee of the Japan Endocrine Society. The Japanese version has already been published, and the essential points have been summarized in this English language version. We recommend diagnostic tests, including measurement of basal cortisol and ACTH levels in combination with a rapid ACTH (250 µg corticotropin) test, the CRH test, and for particular situations the insulin tolerance test. Cut-off values in basal and peak cortisol levels after the rapid ACTH or CRH tests are proposed based on the assumption that a peak cortisol level ≥18 µg/ dL in the insulin tolerance test indicates normal adrenal function. In adult AI patients, 15-25 mg hydrocortisone (HC) in 2-3 daily doses, depending on adrenal reserve and body weight, is a basic replacement regime for AI. In special situations such as sickness, operations, pregnancy and drug interactions, cautious HC dosing or the correct choice of glucocorticoids is necessary. From long-term treatment, optimal diurnal rhythm and concentration of serum cortisol are important for the prevention of cardiovascular disease and osteoporosis. In maintenance therapy during the growth period of patients with 21-hydroxylase deficiency, proper doses of HC should be used, and long-acting glucocorticoids should not be used. Education and carrying an emergency card are essential for the prevention and rapid treatment of adrenal crisis.Key words: Adrenal insufficiency, Adrenal crisis, Cortisol, Hydrocortisone, Congenital adrenal hyperplasia Summary of Recommendations I. Chronic adrenal insufficiency (AI) I-1.0 SymptomsWe recommend suspecting AI in patients who have the following symptoms.

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Section: I-43mentioning

confidence: 99%

Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]

et al. 2016

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“…Adverse effects of these are well known both in localized and systemic adverse effects depending on duration of use and potency of corticosteroid. They can be absorbed through normal skin but more in inflammatory and occlusive skin [4]. Children are more prone to develop systemic reactions to topically applied medication because of their higher ratio of total surface area to body weight [5] and poorly developed skin barrier.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, Therdpong Tempark et al in case report draws attention to application of Clobetasol proproniate for diaper dermatitis in infants. Among 86% infants with diaper dermatitis and 27% with psoriasis, burn, skin dryness were treated with Clobetasol (82%), Bethamethasone (18%) with the duration of application average about 2.75 months induced typical Cushing's features with suppressed cortisol and ACTH levels [4]. Caroline P. Halverstam et.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Cushing syndrome due to topical glicocorticosteroid therapy

Rustowska¹,

Wilkowska²,

Nowicki³

2013

Our Dermatol Online

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Topical glicocorticosteroids are the most common drugs to treat acute and chronic inflammatory skin diseases. Prolonged use of them may cause systemic adverse effects including Cushing's syndrome and hypothalamic-pituitary-adrenal axis suppression. We present a case of four year old girl who developed iatrogenic Cushing syndrome and adrenal insufficiency after atopic dermatitis treatment through the misuse of Mometasone treatment without doctor's prescription. We observe a reddness and a moon face, a buffalo hump, central obesity, ginecomasty, subcutaneous hypertrophy, hirsutism, buttocks muscle atrophy and growth retardation. Wrist X-Ray revealed a bone age of two year old child. Laboratory values revealed hypothalamic-pituitary-adrenal axis suppression. The discontinuation of Mometasone treatment and supplement treatment with oral Hydrocotisone three times per day proved successful in this patient. For this case, the serious side effects of topical glucocorticosteroid treatment should be explained to the family and their long-term therapy should be refrained. Iatrogenic Cushing syndrome in childchood caused by topical treatment is a rare event.

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“…So far, only four cases have been reported in children in Cushing syndrome in infants due to topical glucocorticoid administration is rare and may be underreported (10,12).…”

Section: What Is Known -What Is Knewmentioning

confidence: 99%

Cushing syndrome after bilateral lensectomy

et al. 2014

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Iatrogenic Cushing syndrome induced by oral and parenteral corticosteroid administration is a well-known complication, and necessary precautions have to be taken. Cushing syndrome, however, following treatment with glucocorticoid-containing eye drops is a very rare complication. To the best of our knowledge, there have been only four reported cases in the literature. Herein, we present an infant boy who developed Cushing syndrome after receiving dexamethasone-containing eye drops after bilateral cataract extraction to prevent postoperative inflammatory complications. At the age of 5 months, after approx. 3 months of dexamethasone therapy, the patient presented with cushingoid facies, nephrocalcinosis and failure to grow. Iatrogenic Cushing syndrome was diagnosed and dexamethasone-containing eye drops were reduced and eventually stopped. Follow-up examinations revealed catch-up growth. KeywordsIatrogenic Cushing syndrome; lensectomy; glucocorticoid-containing eye drops; nephrocalcinosis List of Abbreviations ACTH Adrenocorticotropic hormone What is known -What is knewWe present an illustrative and didactic case of Cushing syndrome in an infant due to dexamethasone-containing eye drops. So far, only four cases have been reported in children in 3 49 50 the literature (age range: 11 months to 18 years). The aim of the presented case report is to alert paediatricians to this rare complication of ocular administered glucocorticoids.

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Exogenous Cushing’s syndrome due to topical corticosteroid application: case report and review literature

Cited by 105 publications

References 39 publications

Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]

Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]

Iatrogenic Cushing syndrome due to topical glicocorticosteroid therapy

Cushing syndrome after bilateral lensectomy

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