Iatrogenic Cushing's syndrome and adrenal insufficiency in infants on intranasal dexamethasone drops for nasal obstruction – Case series and literature review

Joshi, Rohan; Maresh, Alison

doi:10.1016/j.ijporl.2017.11.007

Cited by 18 publications

(20 citation statements)

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“…For this short course (10 days) of treatment, we decided to use a 0.2% solution of dexamethasone because it is easily available in 1‐mL ampoules and can be diluted to 2 mL and put in the nebulizer. There is, however, a concern of developing an iatrogenic Cushing syndrome with such administration of dexamethasone; therefore, different glucocorticoids with much lower bioavailability should be used if longer treatment is considered …”

Section: Discussionmentioning

confidence: 99%

“…There is, however, a concern of developing an iatrogenic Cushing syndrome with such administration of dexamethasone; therefore, different glucocorticoids with much lower bioavailability should be used if longer treatment is considered. [34][35][36][37][38] With better understanding of the underlying pathophysiology of CRS, most experts now agree that the main focus of therapy is controlling the inflammation and mucosal edema that impair drainage, which leads to secondary infections and exacerbations of all forms of CRS from time to time. These events aggravate symptoms and have significant influence on patient QOL.…”

Section: Discussionmentioning

confidence: 99%

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Inhalation Aerosol Therapy in the Treatment of Chronic Rhinosinusitis: A Prospective Randomized Study

Velepić

Manestar

Perković

et al. 2019

The Journal of Clinical Pharma

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The purpose of the study was to compare treatment of chronic rhinosinusitis (CRS) with topical glucocorticoids and saline irrigation versus aerosol inhalation therapy. Patients diagnosed with CRS were randomly divided into 2 groups. In the first group, patients were treated with topical glucocorticoids (mometasone furoate, 100 µg in each nostril once daily) and saline irrigation (150 mL twice a day) for 2 weeks. In the second group, patients were treated with inhalation aerosol therapy composed of essential oils, saline, glucocorticoids, and antibiotics, once daily 5 times per week (Monday through Friday), for 2 weeks. The effect of the treatments was compared between the 2 groups. In the first group there was no significant improvement in the Glasgow Health Status Inventory (GHSI) (P = .29). In the second group the improvement in GHSI score was significant (P = .037). It was shown that in the first group the Glasgow Benefit Inventory score was significantly lower than in the second group (P = .002), which means that the improvement in the health status after the therapy was better in the second group. A Lund‐Kennedy score showed statistical improvement in both groups (both P < .001). Improvement was also compared between the groups. The results were not significant (P = .11). The authors concluded that, in this preliminary research, inhalation aerosol therapy composed of essential oils, saline, glucocorticoids, and antibiotics led to better subjective results than intranasal glucocorticoid therapy and saline irrigation in the treatment of CRS. Further investigations with more participants, longer periods of treatment, and different validation tools are needed to confirm our results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Inhalation Aerosol Therapy in the Treatment of Chronic Rhinosinusitis: A Prospective Randomized Study

Velepić

Manestar

Perković

et al. 2019

The Journal of Clinical Pharma

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“…La presentación del síndrome depende (3) de la dosis de corticoides administrada y la duración del tratamiento . En el caso de las gotas nasales es importante la cantidad de gotas administradas cada día y la cantidad total absorbida por la mucosa (4) nasal bastante irrigada por vasos sanguíneos . Cualquier exposición a corticoides superior a 4 semanas acarrea el riesgo de atrofia de la corteza adrenal, con la consiguiente supresión de la secreción de la ACTH y la retroalimentación negativa del eje hipotalámico-pituitario-adrenal.…”

Section: Caso Clínicounclassified

“…Nuevos compuestos esteroideos, como el propinato y el fluorato de fluticasona y el fluorato de mometasona tienen una tasa de absorción sistémica <0,1% cuando son administrados intranasalmente. Además, tienen un rápido y extenso metabolismo de primer paso de (4) la porción que es ingerida, por lo que no causarían alteraciones en el eje hipofisario-adrenal .…”

Section: Caso Clínicounclassified

Adrenal insufficiency secondary to chronic use of topical nasal corticosteroids

González

Medina

2020

Rev. virtual Soc. Parag. Med. Int

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“…There are several case reports demonstrating intranasal dexamethasone drops causing iatrogenic Cushing's syndrome and adrenal insufficiency. [15][16][17] Furthermore, several studies have validated the short-term safety of budesonide nasal irrigations with one study noting concern with long-term use of the medication. [18][19][20] Few controlled studies have studied the benefits of high-dose topical steroid use, and none have specifically evaluated the efficacy of dexamethasone spray.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Dexamethasone Versus Fluticasone Nasal Sprays in Postoperative Patients With Chronic Rhinosinusitis With Nasal Polyps

Seiberling

Kidd

Kim

et al. 2019

Am J Rhinol�Allergy

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Background Topical nasal steroids are commonly prescribed to patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) following endoscopic sinus surgery (ESS). They are found to be effective in improving symptoms and quality of life as well as reducing the incidence of nasal polyps recurrence. Objective We sought to determine whether a higher concentration of topical nasal steroid spray is more effective than the standard nasal steroid spray in controlling symptoms and preventing recurrence of polyps in patients with CRSwNP who underwent ESS. Method A double-blind randomized controlled trial was performed on patients with CRSwNP after ESS. Patients were randomized into 2 treatment groups: one received topical nasal dexamethasone 0.032% and the other, fluticasone proprionate. The 22-item Sino-Nasal Outcome Test (SNOT-22) and Lund-Kennedy nasal endoscopy scores were measured at the initiation of topical nasal steroid treatment and then at approximately 4-, 8-, and 12-week intervals. Results Thirty-nine patients were enrolled in the study. Eighteen patients continued using the medications prescribed to them for the duration of the study. There were 8 patients in the dexamethasone group and 10 patients in the fluticasone group. Both groups saw significant improvements in postoperative SNOT-22 and Lund-Kenney scores over time. There was no significant difference in improvement between the groups. Conclusion There is no significant increased benefit in using a higher dose nasal steroid spray compared to the standard dose nasal steroid spray after ESS.

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Iatrogenic Cushing's syndrome and adrenal insufficiency in infants on intranasal dexamethasone drops for nasal obstruction – Case series and literature review

Cited by 18 publications

References 18 publications

Inhalation Aerosol Therapy in the Treatment of Chronic Rhinosinusitis: A Prospective Randomized Study

Inhalation Aerosol Therapy in the Treatment of Chronic Rhinosinusitis: A Prospective Randomized Study

Adrenal insufficiency secondary to chronic use of topical nasal corticosteroids

Efficacy of Dexamethasone Versus Fluticasone Nasal Sprays in Postoperative Patients With Chronic Rhinosinusitis With Nasal Polyps

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