Document Detail


Cushing's syndrome and adrenocortical insufficiency caused by topical steroids: misuse or abuse?
MedLine Citation:
PMID:  18183788     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Prolonged application of topical steroids transiently suppresses the hypothalamic-pituitary-adrenal axis (HPA). Infants who are exposed to topical corticosteroids have greater risk for Cushing's syndrome or adrenocortical insufficiency caused by suppression of the HPA axis because glucocorticoids are highly absorbed through the diaper area. Here, we report six infants (four girls, two boys) aged between 3 and 8 months who were exposed to potent topical corticosteroids (clobetasol propionate and diflucortolone valerate) by the mother's application without prescription. METHODS: We examined the HPA axis and other side effects of the potent glucocorticoid therapy in these infants. After stopping the topical corticosteroid, serum AST, ALT, lipids, morning cortisol and ACTH levels were measured. A low dose ACTH stimulation test was carried out. Hydrocortisone was started for the prevention of glucocorticoid withdrawal syndrome and the dose was gradually decreased. Abdominal ultrasonography was performed to investigate hepatosteatosis. RESULTS: The ACTH stimulation test showed suppression of the HPA axis in these infants. Hepatomegaly was found in all infants and three of them had hepatosteatosis. Liver transaminase levels were elevated in five infants. Five patients have been followed for 6-14 months. One infant died due to generalized Cytomegalovirus infection. CONCLUSION: We emphasize that physicians should be alert for the dangerous side-effects of topical steroids and they should avoid long-term use. Furthermore, parents should be informed about the side-effects when topical steroid treatment is chosen.
Authors:
Ayla Güven; Ozlem Gülümser; Tolga Ozgen
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of pediatric endocrinology & metabolism : JPEM     Volume:  20     ISSN:  0334-018X     ISO Abbreviation:  J. Pediatr. Endocrinol. Metab.     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2008-01-10     Completed Date:  2008-01-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9508900     Medline TA:  J Pediatr Endocrinol Metab     Country:  England    
Other Details:
Languages:  eng     Pagination:  1173-82     Citation Subset:  IM    
Affiliation:
Department of Pediatric Endocrinology, Ondokuz Mayis University Medical Faculty, Turkey. aylaguven@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Administration, Topical
Adrenal Insufficiency / blood,  chemically induced*,  diagnosis
Adrenocorticotropic Hormone / blood,  diagnostic use
Anti-Inflammatory Agents / administration & dosage,  adverse effects*,  contraindications
Clinical Chemistry Tests
Clobetasol / adverse effects*,  contraindications
Cushing Syndrome / blood,  chemically induced*,  diagnosis
Diaper Rash / blood,  drug therapy,  pathology
Diflucortolone / administration & dosage,  adverse effects,  analogs & derivatives*,  contraindications
Fatal Outcome
Female
Glucocorticoids / administration & dosage,  adverse effects*,  contraindications
Humans
Hydrocortisone / blood
Hypothalamo-Hypophyseal System / drug effects,  physiopathology
Infant
Male
Overdose
Pituitary-Adrenal System / drug effects,  physiopathology
Chemical
Reg. No./Substance:
0/Anti-Inflammatory Agents; 0/Glucocorticoids; 25122-41-2/Clobetasol; 2607-06-9/Diflucortolone; 50-23-7/Hydrocortisone; 59198-70-8/diflucortolone valerate; 9002-60-2/Adrenocorticotropic Hormone
Comments/Corrections
Comment In:
J Pediatr Endocrinol Metab. 2007 Nov;20(11):1169-71   [PMID:  18183787 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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