Pituitary–adrenal axis suppression due to topical steroid administration in an infant

Atabek, Mehmet Emre; Pirgon, Özgür; Ünal, Ekrem

doi:10.1111/j.1442-200x.2007.02330.x

Cited by 10 publications

(10 citation statements)

References 8 publications

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“…In Fig. 1, low level of CP mean absorption was described and a cumulative increase with times of applications, as previously suggested by Atabek (10, 25), can be observed. Moreover, epithelial stratum corneum can serve as drug reservoir for topically applied compounds (as steroids), permitting an increasing local drug deposition and, thus, sustaining slow release over the time (26).…”

Section: Discussionsupporting

confidence: 81%

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Pharmacokinetics study about topical clobetasol on oral mucosa

Varoni

Molteni

Sardella

et al. 2011

J Oral Pathology Medicine

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Section: Discussionsupporting

confidence: 81%

“…Adrenal suppression, following cutaneous application of CP, has been well described, mainly after long-term or high-dose treatments, principally in children, or when employed onto thin skin sites (armpit and forearm) or onto erosive-atrophic lesions (5)(6)(7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetics study about topical clobetasol on oral mucosa

Varoni

Molteni

Sardella

et al. 2011

J Oral Pathology Medicine

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“…The previous reports summary of Iatrogenic Cushing syndrome due to topical steroid in children and adult were shown in Table 1A [1][2][3][4][5][6][7][8][9][10][11][12][13][14] and B [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31], respectively. Most affected cases in children group (Table 1A) were an infant (86%) with diaper dermatitis, and the other primary diseases (27%) were Psoriasis, burn, skin dryness.…”

Section: Introductionmentioning

confidence: 99%

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

Tempark

Phatarakijnirund

Chatproedprai

et al. 2010

Endocr

108

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Prolonged use of topical corticosteroids causes systemic adverse effects including Cushing's syndrome and hypothalamic-pituitary-adrenal (HPA) axis suppression, which is less common than that of the oral or parenteral route. At least 43 cases with iatrogenic Cushing syndrome from very potent topical steroid usage (Clobetasol) in children and adult have been published over the last 35 years particularly in developing countries. In children group (n = 22), most are infants with diaper dermatitis and two cases who had started topical application at a very early age and died from severe disseminated CMV infection. For the adult group (n = 21), the most common purpose of steroid use was for treatment of Psoriasis. The recovery period of HPA axis suppression was 3.49 ± 2.92 and 3.84 ± 2.51 months in children and adult, respectively. We report on an 8-month-old female infant who developed Cushing's syndrome and adrenal insufficiency after diaper dermatitis treatment through the misuse of Clobetasol without doctor's prescription. Physiologic dose of hydrocortisone was prescribed to prevent an adrenal crisis for 3 months and discontinued when HPA axis recovery was confirmed by normal morning cortisol and ACTH levels.

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“…On the contrary, every topical steroid preparation may cause iatrogenic Cushing syndrome, especially when incorrectly used. Very few case reports regarding iatrogenic Cushing syndrome caused by topical steroids are reported in the paediatric literature and they are more frequently caused by dermatological and inhaled glucocorticoids 4 , 5 , 12 – 14. According to our knowledge, Cushing syndrome caused by ocular steroid drops is an exceptional event and only three case reports are cited in the Medline database to date6 – 8 in paediatric age and only one in adulthood 15…”

Section: Discussionmentioning

confidence: 99%

“…But it is important to underline that every topic steroid has a systemic absorption and may potentially cause iatrogenic Cushing syndrome, although this is a very rare and unusual event 3. Most of these cases have been caused by rhinologic4 and dermatological5 preparations and only three reports of iatrogenic Cushing syndrome by ocular steroids have been described in paediatric literature 6 – 8…”

Section: Introductionmentioning

confidence: 99%

Iatrogenic Cushing syndrome caused by ocular glucocorticoids in a child

Messina

Valenzise²,

Aversa³

et al. 2009

Case Reports

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A boy aged 7.6 years presented to our Unit of Paediatric Endocrinology for evaluation of obesity. Progressive weight gain (10 kg) started 6 months earlier after an accidental penetrating orbital injury on the right eye. During this period the child has been treated with oral betamethasone (0.5 mg/day) for 1 month and dexamethasone 2% ocular drops (2 hourly by day) for 6 months. Physical examination showed he was 113.5 cm in height (-1.5 SD), weight 36.0 kg, blood pressure 110/90 mmHg (90th centile), body mass index 28 (+5 SD), truncal obesity, buffalo hump, "moon-face", increased lanugo hair and supraclavicular fullness. Endocrinological work-up revealed undetectable levels of basal adrenocorticotropic hormone (ACTH), basal and ACTH-stimulated cortisol and 24 h urine excretion cortisol, confirming the diagnosis of iatrogenic Cushing syndrome. The abrupt withdrawal of ocular glucocorticoids by the parents evoked two adrenal crises; 4 months later the patient recovered. In conclusion, we would alert doctors that every formulation of glucocorticoids, no ocular drops excluded, can determine severe systemic side effects and iatrogenic Cushing syndrome.

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Pituitary–adrenal axis suppression due to topical steroid administration in an infant

Cited by 10 publications

References 8 publications

Pharmacokinetics study about topical clobetasol on oral mucosa

Pharmacokinetics study about topical clobetasol on oral mucosa

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

Iatrogenic Cushing syndrome caused by ocular glucocorticoids in a child

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