Temporary inhibition of growth and adrenal suppression associated with the use of steroid nose drops

Abstract

Inhibition of growth and adrenal suppression are reported following the use of intranasal beta-methasone (0.1%) in a 9-year-old boy with cystic fibrosis and nasal polyps and in a 3-year-old girl with allergic rhinitis. On stopping treatment catch-up growth occurred and adrenal function returned to normal.

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

“…The systemic side‐effects of these agents occur relatively infrequently but may involve pituitary–adrenal axis suppression and hypocorticism, with possible growth retardation in children. Growth arrest and Cushing’s syndrome have been reported after long‐term topical application of hydrocortisone in children 8,9 . Consequently, to reduce the risk of these untoward side‐effects, the Food and Drug Administration is recommending that the current label be amended to advise health practitioners that height and weight should be measured regularly in children receiving these drugs 10 .…”

Intranasal ciclesonide for allergic rhinitis

“…An absence of adrenal suppression has also been reported for budesonide, triamcinolone and mometasone (Wilson et al 1998). Importantly, the use of betamethasone nasal drops has been reported to affect growth (Daman Willems et al 1994;Skoner et al 2000), although the later study did not have age or height controls. No studies have examined growth velocity in children treated with nasal ciclesonide; however an inhaled dose of 160 mg daily (to treat asthma) in children aged 4 to 11 years did not show any modifi cation of adrenal function (Gelfand et al 2006) or any signifi cant change in growth of children aged 5 to 8 over a period of 1 year (Skoner et al 2008).…”

Hypothalamic‐pituitary‐adrenal axis suppression and intranasal corticosteroid use: A systematic review and meta‐analysis

“…For example, betamethasone used as drops demonstrated several cases of AI, 36,37,50 whereas INSI resulted in no cases of AI 49 . This could be explained by previous studies showing that betamethasone drops were more likely to result in systemic absorption and HPA suppression 53–58 . Previous reports also associated use of betamethasone nasal drops (Betnesol) with a higher prevalence of AI, as these preparations are not available in a metered dropper delivery system, enabling patients to overmedicate 59 .…”

“…49 This could be explained by previous studies showing that betamethasone drops were more likely to result in systemic absorption and HPA suppression. [53][54][55][56][57][58] Previous reports also associated use of betamethasone nasal drops (Betnesol) with a higher prevalence of AI, as these preparations are not available in a metered dropper delivery system, enabling patients to overmedicate. 59 Importantly, there were no studies on betamethasone assessing AI over a short duration; however, several cases of AI were demonstrated in medium (18 of 33) 36,37 and long (11 of 24) 50 durations-with the exception of Dawson et al, who used INSI as the method of administration.…”