Cushing’s syndrome: hidden risk in usage of topical corticosteroids
-
Ayşe Derya Buluş
,
Nesibe Andıran
Abstract
Iatrogenic Cushing’s syndrome in children may occur as a result of the application of exogenous steroids. Prolonged use of powerful corticosteroids suppresses adrenal functions and iatrogenic Cushing’s syndrome may develop particularly in infants who are given topical corticosteroids. We report here a case on three infants having Cushing’s syndrome with similar clinical presentations due to overuse of topical steroids for diaper dermatitis. The importance of exercising caution during the use of topical steroids is underlined in this study.
References
1. Allen DB. Safety of inhaled corticosteroids in children. Pediatr Pulmonol 2002;33:208–20.10.1002/ppul.10040Search in Google Scholar
2. Hengge UR, Ruzicka T, Shwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol 2006;54:1–15.10.1016/j.jaad.2005.01.010Search in Google Scholar
3. Wolkerstorfer A, Visser RL, De Waard van der Spek FB, Mulder PG, Oranje AP. Efficacy and safety of wet-wrap dressings in children with severe atopic dermatitis: influence of corticosteroid dilution. Br J Dermatol 2000;143:999–1004.10.1046/j.1365-2133.2000.03833.xSearch in Google Scholar
4. Şıklar Z, Bostancı I, Atli O, Dallar Y. An infantile Cushing syndrome due to misuse of topical steroid. Pediatr Dermatol 2004;21:561–3.10.1111/j.0736-8046.2004.21508.xSearch in Google Scholar
5. Andıran N. “Diaper Dermatit” ten Cushing Sendromuna. Yeni Tıp Dergisi 2007;24:112–4.Search in Google Scholar
6. Güven A, Gülümser O, Özgen T. Cushing’s syndrome and adrenocortical insufficiency caused by topical steroids: misuse or abuse? J Pediatr Endocrinol Metab 2007;20:1173–82.10.1515/JPEM.2007.20.11.1173Search in Google Scholar
7. Semiz S, Yasemin BI, Ergin Ş, Candemir M, Polat A. Two cases of Cushing’s syndrome due to overuse of topical steroid in the diaper area. Pediatric Dermatol 2008;5:544–7.10.1111/j.1525-1470.2008.00735.xSearch in Google Scholar
8. Gilbertson EO, Spellman MC, Piacquadio DJ, Mulford MI. Super potent topical corticosteroid use associated with adrenal suppression: clinical considerations. J Am Acad Dermatol 1998;38:318–21.10.1016/S0190-9622(98)70573-0Search in Google Scholar
9. Nield LS, Kamat D. Prevention, diagnosis and management of diaper dermatitis. Clin Pediatr 2007;6:480–6.Search in Google Scholar
10. Boumpas DT, Paliogianni F, Anastassiou ED. Glucocorticosteroid action on the immune system: molecular and cellular aspects. Clin Exp Rheumatol 1991;9:413–23.Search in Google Scholar
11. Boscaro M, Barzon L, Fallo F, Sonino N. Cushing’s syndrome. Lancet 2001;357:783–91.10.1016/S0140-6736(00)04172-6Search in Google Scholar
12. Baş VN, Çetinkaya S, Aycan Z. Iatrogenic Cushing syndrome due to nasal steroid drops. Eur J Pediatr 2012;171:735–6.10.1007/s00431-011-1645-9Search in Google Scholar PubMed
13. Ference JD, Last AR. Choosing topical corticosteroids. Am Fam Phys 2009;79:135–40.Search in Google Scholar
14. Tordjman K, Jaffe A, Trostanetsky Y, Greenman Y, Limor R, et al. Low dose (1 μg) adrenocortocotrophin (ACTH) stimulation as a screening test for impaired hypothalamo-pituitary-adrenal axis function: sensitivity, specificity and accuracy in comparison with the high dose (250 μg) test. Clin Endocrinol 2000;52:633–40.10.1046/j.1365-2265.2000.00984.xSearch in Google Scholar PubMed
15. Crowley S, Hindmarsh PC, Honour JW, Brook CGD. Reproducibility of the cortisol response to stimulation with a low dose of ACTH: the effect of basal cortisol levels and comparison of low-dose with high-dose secretory dynamics. J Endocrinol 1993;136:167–72.10.1677/joe.0.1360167Search in Google Scholar PubMed
16. Colao A, Pivanello R. The diagnosis of secondary adrenal insufficiency: low dose vs high dose ACTH stimulation test. J Endocrinol Invest 2003;26:1–2.10.1007/BF03345114Search in Google Scholar PubMed
©2014 by De Gruyter
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- Counseling patients with succinate dehydrogenase subunit defects: genetics, preventive guidelines, and dealing with uncertainty
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- Permanent neonatal diabetes mellitus in Jordan
- The effect of adenotonsilectomy on ghrelin, leptin, IGF-1 levels and growth parameters in children with adenotonsillar hypertrophy
- The role of anti-Mullerian and inhibin B hormones in the evaluation of 46,XY disorders of sex development
- The evaluation of thyroid carcinoma in childhood and concomitance of autoimmune thyroid disorders
- Lipid patterns in treated growth hormone deficient children vs. short stature controls
- Assessment of aortic morphology and compliance in children and adolescents with Ullrich-Turner syndrome (UTS) using magnetic resonance imaging (MRI)
- Management of central diabetes insipidus with oral desmopressin lyophilisate in infants
- Maternal factors and complications of preterm birth associated with neonatal thyroid stimulating hormone
- Patient reports
- A rare case of pituitary infarction leading to spontaneous tumour resolution and CSF-sella syndrome in an 11-year-old girl and a review of the paediatric literature
- Rare case of homozygous epimerase deficiency and heterozygous of duarte 2 variant
- Persistent congenital hyperinsulinism in two patients with Beckwith-Wiedemann syndrome due to mosaic uniparental disomy 11p
- Growth hormone treatment in a patient with Hurler-Scheie syndrome
- Neonatal diagnosis of a patient with hypoparathyroidism, sensorineural deafness and renal dysplasia (HDR) syndrome associated with cerebral infarction
- Early-onset diabetes mellitus and neurodevelopmental retardation: the first Greek case of Wolcott-Rallison syndrome
- Type III Bartter-like syndrome in an infant boy with Gitelman syndrome and autosomal dominant familial neurohypophyseal diabetes insipidus
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- Prader-Willi syndrome: a case report with atypical developmental features
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