Lesson of the week: Childhood Cushing's syndrome induced by betamethasone nose drops, and repeat prescriptions

Findlay, Christine; MacDonald, J. Fred; Wallace, Andrew M.; Geddes, N.K.; Donaldson, M D C

doi:10.1136/bmj.317.7160.739

Cited by 59 publications

(63 citation statements)

References 6 publications

(3 reference statements)

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“…Messina et al, 16 reported progressive weight gain (10kg) over six months in a 7.6-year-old boy with Cushing's syndrome due to dexamethasone 2% ocular drops. Findlay et al, 17 described two cases who developed iatrogenic Cushing's syndrome induced by prolonged use of intranasal betamethasone. The first case was a seven-year-old boy whose weight during the two years prior to admission had increased from the 50th to the 97th centile with height falling from the 10th to the 3rd centile.…”

Section: Discussionmentioning

confidence: 98%

Linear Growth Arrest Without Weight Gain Due to Overuse of Topical Clobetasol

Razavi¹,

Sanginabadi²

2014

Oman Med J

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Prolonged potent topical glucocorticoid therapy in infants can cause iatrogenic Cushing's syndrome. This case highlights the rarity of poor weight gain in iatrogenic Cushing's syndrome. A 17-month-old boy was referred to outpatients pediatric endocrine clinic for evaluation of growth failure. On presentation his weight was 9.7kg (5th percentile) and height was 72cm (-3.6 SD below mean for age and sex). Systemic examination revealed grossly moon-like face, hypertrichosis and thin skin in the genital area. His mother reported using local clobetasol for the previous seven months for his diaper dermatitis. Baseline plasma cortisol was low (0.3ng/ml, normal range: 60 to 280ng/ml). During standard dose of synthetic adrenocorticotropic hormone test, the peak cortisol level was 0.4ng/ml (N>180ng/ml) and was consistent with hypothalamic-pituitary-adrenal axis suppression. The patient's clinical presentation and laboratory investigations confirmed the diagnosis of secondary adrenal insufficiency and iatrogenic Cushing's syndrome. He was treated successfully by discontinuing use of clobetasol. His appearance and growth returned to normal within two months. Morning cortisol was 101.2ng/ml after stopping the oral physiologic dose of hydrocortisone. Our case differed from other reports of iatrogenic Cushing's syndrome by presenting in poor weight gain rather than obesity.

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Section: Discussionmentioning

confidence: 98%

Linear Growth Arrest Without Weight Gain Due to Overuse of Topical Clobetasol

Razavi¹,

Sanginabadi²

2014

Oman Med J

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“…Paterson cites the cases reported by Findlay et al 1 These authors reported on two patients who developed Cushing's syndrome while taking betamethasone nose drops; they also found four similar case reports for the 18 years from 1980, concerning three patients taking betamethasone and one taking dexamethasone nose drops. These agents have a high potential for systemic bioavailability, and our systematic review did not include any comparison with these agents.…”

Section: Wwwbmjcom Letters@bmjcommentioning

confidence: 89%

“…5 Once an intervention is recommended from evidence based data it is incumbent on the clinician to decide on the dose, duration of treatment, follow up, and risk:benefit ratio in consultation with the patient. 1 1 The authors highlight the prohibitive cost of zidovudine and suggest that placebo controlled trials should be revived.…”

Section: Wwwbmjcom Letters@bmjcommentioning

confidence: 99%

Intranasal corticosteroids in allergic rhinitis

1999

BMJ

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“…However, it may be much more difficult in children treated with locally delivered steroids e.g. by inhalation or in dermatological preparations (5,10). Cushing syndrome as a result of topical ocular steroids is a rare and probably underreported complication in infants and children.…”

Section: Discussionmentioning

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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Lesson of the week: Childhood Cushing's syndrome induced by betamethasone nose drops, and repeat prescriptions

Cited by 59 publications

References 6 publications

Linear Growth Arrest Without Weight Gain Due to Overuse of Topical Clobetasol

Linear Growth Arrest Without Weight Gain Due to Overuse of Topical Clobetasol

Intranasal corticosteroids in allergic rhinitis

Cushing syndrome after bilateral lensectomy

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